184例儿童与成人横纹肌肉瘤的比较研究

目的 比较分析儿童与成人横纹肌肉瘤的预后差别及其临床影响因素.方法 回顾性分析天津医科大学肿瘤医院1993年1月至2009年6月间经病理确诊为横纹肌肉瘤且有完整随访资料的184例患者,其中分为儿童组93例(≤18周岁)和成人组91例(＞18周岁).结果 1年、3年、5年生存率儿童组分别为90.3％、62.0％、43.1％,成人组分别为86.8％、35.1％、20.0％.两组间1年生存率差异无统计学意义(P=0.454),但3年(P=0.001)和5年(P=0.007)生存率成人组均低于儿童组,并且Kaplan-Meier生存曲线也提示成人组(中位生存期26.7个月)低于儿童组(中位生存期47.3个月),Log-rank检验两生存曲线差异有统计学意义(P=0.003).多因素分析显示组织学类型、原发部位和术后分组是儿童RMS预后的独立影响因素,组织学类型、原发肿瘤大小和术后分组是成人RMS预后的独立影响因素.x2检验显示儿童组与成人组在组织学类型(胚胎型:77.4％、27.5％;腺泡或多形性:22.6％、72.5％;P=0.000)、原发部位(预后好的部位:40.9％、22.0％;预后不好部位:59.1％、78.0％;P=0.006)和远处转移(无转移:87.1％、73.6％;有转移:12.9％、26.4％;P=0.021)因素的差异具有统计学意义.结论 成人RMS的预后明显差于儿童,组织学类型、原发部位和远处转移的差异是导致这种差别的可能因素.

Comparative study on 184 pediatric and adult patients with rhabdomyosarcoma

Objective To compare the prognostic factors and clinical differences between pediatric and adult rhabdomyosarcoma.Methods We reviewed the clinical data of 184 patients who were diagnosed to have RMS by pathology and had complete follow-up data between January 1993 and June 2009 in the Cancer Institute and Hospital of Tianjin Medical University.There were 93 pediatric patients (age≤18 years) and 91 adult patients (age＞18 years).Results The 1-,3-and 5-year survival rates in the pediatric group were 90.3％,62.0％,43.1％,respectively,while these were 86.8％,35.1％,20.0％,respectively in the adult group.No significant statistical difference was seen in the 1-year survival rates (P =0.454) between the two groups.However the adult group had significantly lower 3-year (P =0.001 ) and 5-year (P =0.007) survival rates.Kaplan-Meier curve also showed that the adult group ( Median survival 26.7 months) had a lower survival rate than the pediatric group (Median survival 47.3 months,Log-rank test P =0.003).Multivariate analysis showed that the histological subtypes,primary site and post-surgical stratification were independent prognostic factors for pediatric RMS,while the histological subtypes,tumor size and post-surgical stratification were responsible for adult RMS prognosis.Significant statistical differences were showed between the pediatric group and adult group in the factors of histological subtypes(Embryonal:77.4 ％ vs 27.5 ％ ; Alveolar or Pleomorphic:22.6％ vs 72.5％ ;P =0.000),primary site(Favorable site:40.9％ vs 22.0％ ; Unfavorable site:59.1％ vs 78.0 ％ ; P =0.006) and distant metastasis(No metastasis:87.1 ％ vs 73.6 ％％ ;Metastasis:12.9％ vs 26.4％ ; P =0.021 ) by Chi-square Test.Conclusions The prognosis of adult RMS is significantly worse than pediatric tumor,and the differences of the histological subtypes,primary site and distant metastases between the two groups should be responsible for it.