本文選題：神經(jīng)母細胞瘤　切入點：兒童　出處：《上海交通大學(xué)》2014年碩士論文

【摘要】：目的探討兒童神經(jīng)母細胞瘤（Neuroblastoma，NB）的臨床特征及預(yù)后影響因素。 方法回顧性分析2007年1月至2012年12月我院收治且隨訪資料完整的92例NB患兒臨床資料，比較不同因素對預(yù)后的影響。 結(jié)果92例患兒中，男女比例為1.5:1，中位診斷年齡為32.3個月（2.0-159.8個月）,中位隨訪時間為32個月（12-80個月）。5年總體生存率（5y-OS）為65.9%±5.4%，5年無事件生存率（5y-EFS）為56.2%±5.7%。92例NB中29例出現(xiàn)復(fù)發(fā)、進展，中位復(fù)發(fā)進展時間為確診后11.0個月（1.1-27.5個月），復(fù)發(fā)、進展后3y-OS為23.5%±8.8%，診斷后18個月內(nèi)復(fù)發(fā)的患兒較18個月后復(fù)發(fā)的患兒預(yù)后差（7.3%±6.8%vs80.0%±17.9%，P=0.006）。本組共有28例（30.4%）患兒死亡，死亡首要原因是腫瘤進展所致（20/28,71.4%），，其次為化療相關(guān)的嚴(yán)重感染（6/28,21.4%）。單因素分析顯示INSS分期（P=0.001）、危險度分層（P=0.001）、LDH＞500U/L （P=0.033）、骨骼轉(zhuǎn)移（P=0.004）、N-myc基因擴增（P=0.016）是影響總體生存率的重要因素。多因素分析顯示INSS分期（P=0.013）、N-myc基因擴增（P=0.022）為獨立的預(yù)后影響因素。 結(jié)論INSS分期和N-myc基因的擴增狀態(tài)是影響NB患者預(yù)后的獨立因素。應(yīng)重視強烈化療后并發(fā)嚴(yán)重感染導(dǎo)致的死亡事件。診斷后18個月內(nèi)復(fù)發(fā)的患兒預(yù)后較差，但I和II期或僅原發(fā)部位提示復(fù)發(fā)的患兒，在首次復(fù)發(fā)后予以積極治療仍可獲得長期生存。聯(lián)合治療包括化療、手術(shù)、放療和自體干細胞移植可改善高危與極高危NB患兒的預(yù)后。
[Abstract]:Objective to investigate the clinical features and prognostic factors of neuroblastomaena NB in children with neuroblastomas. Methods the clinical data of 92 cases of NB patients with complete follow-up data from January 2007 to December 2012 were analyzed retrospectively and the effects of different factors on prognosis were compared. Results in 92 cases, the ratio of male to female was 1.5: 1, the median diagnostic age was 32.3 months (2.0-159.8 months), the median follow-up time was 32 months (12-80 months), the overall 5-year survival rate (5y-OS) was 65.9% 鹵5.4%, the 5-year event-free survival rate (5y-EFS) was 56.2% 鹵5.7.92 cases of NB recurred and progressed. The median time of recurrence and progression was 1.1-27.5 months after diagnosis, and the 3y-OS after progression was 23.5% 鹵8.8%. The prognosis of children with recurrence within 18 months after diagnosis was 7.3% 鹵6.8vs80.0% 鹵17.9% 鹵17.9P0.006. There were 28 cases of death in this group. The leading cause of death was 20 / 28 / 71.4%, followed by chemotherapy-related severe infection (6 / 28 / 21. 4). Univariate analysis showed that INSS staging was 0. 001%, 500U/L was higher than P0. 033, bone metastasis P0. 004 N-myc gene amplification (P0. 016) was an important factor affecting overall survival rate. Factor analysis showed that INSS staging was an independent prognostic factor with the amplification of N-myc gene (P0. 022). Conclusion the stage of INSS and the amplification status of N-myc gene are independent factors influencing the prognosis of NB patients. We should pay attention to the death events caused by severe infection after intensive chemotherapy. The prognosis of children with recurrence within 18 months after diagnosis is poor. However, children with stage I and II or only primary sites who indicate recurrence may still be able to survive long term after active treatment after the first recurrence. Combination therapy includes chemotherapy, surgery, Radiotherapy and autologous stem cell transplantation can improve the prognosis of children with high and very high risk NB.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.4

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相關(guān)期刊論文 前1條

1 蔣馬偉;吳曄明;周仁華;陸冬青;吳國華;袁曉軍;;17例Ⅳ期高危神經(jīng)母細胞瘤腫瘤包繞大血管放療介入診治分析[J];中國腫瘤臨床;2012年15期

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