PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析*

目的 探讨儿童肝母细胞瘤（HB）PRETEXT分期系统和CT征象在疗效评估中的应用价值。方法 2013年1月~2016年8月经组织病理学检查确诊的47例HB患儿,回顾性分析其CT检查资料,以术后组织病理学检查结果为参照,分析术前PRETEXT分期系统的正确性,并分析不同病理学分型患儿肿瘤边界、形态、出血、钙化和囊变坏死程度等CT征象的异同。结果 本组单纯上皮型30例（63.8%）,上皮与间叶混合型17例（36.2%）;8例直接手术患儿术前PRETEXT分期6例为II期,2例为III期,均与术后病理学诊断分期相符,39例化疗后手术患儿术前和术后PRETEXT分期准确率为79.5%（31/39）;在47例患儿中,术前PRETEXTCT分期与术后病理学判定比,其准确率达83.0%（39/47）;钙化多见于上皮与间叶混合型,本组病例中MDCT显示10例出现钙化,其中上皮与间叶混合型者8例,显著多于单纯上皮型（x²=8.313,P=0.004）。结论 PRETEXT术前和术后分期诊断HB患儿的准确率较高,结合特征性CT征象可提示组织病理学分型,为HB临床决策提供较为可靠的依据。

Application of PRETEXT staging system in evaluating treatment response of children with hepatoblastoma

Objective To evaluate the value of PRETEXT staging system and CT imaging features in evaluating treatment response of pediatric hepatoblastoma （HB）. Methods The multi-detector CT imaging features in 47 children with pathologically confirmed HB were retrospectively reviewed between January 2013 and August 2016. The consistency between PRETEXT stage and post-surgical pathological grade was assessed. The CT imaging findings, including tumor margin,morphology,intra-tumor hemorrhage,calcification and intra-tumor cystic necrosis, and pathological grades was evaluated. Results Out of 47 children with HB,30（63.8%） were pathological-proven epithelial,and 17（36.2%） with epithelial-mesenchymal type;eight children with HB,including 6 with PRETEXT stage II and 2 with PRETEXT stage III, received surgery without chemotherapy,and their PRETEXT stages was completely consistent with pathological-proven grade, and the accuracy rate between POSTTEXT stages and pathological grades reached 79.5% （31/39） in 39 children receiving surgery after chemotherapy;the overall accuracy of PRETEXT stage was 83.0% as compared with post-surgical pathological grade;out of ten children with tumor calcification,eight was with epithelial-mesenchymal type tumor, much higher than in with epithelial type （x²=8.313,P=0.004）. Conclusion The PRETEXT stage is well consistent with post-surgical grade, and it might predict the pathological grade in consideration of specific image findings,which is helpful in determining management strategy of children with HB.