晚期儿童肝母细胞瘤的预后分析

目的：探讨晚期儿童肝母细胞瘤（hepatoblastoma，HB）的预后情况。方法回顾性分析首都医科大学附属北京同仁医院儿科2006年4月-2014年7月收治的103例患儿中随访3年以上的30例晚期HB患儿的临床资料，总结其临床疗效和预后情况。结果（1）POG／CCG临床分期：III期12例，完全缓解（CR）10例（83％）；IV期18例，CR 8例（44％），两组CR率无显著差异（P＝0.08）；（2）血清AFP：30例患儿中28例明显升高，占93％；（3）术前化疗：提高了69％的肿瘤完全切除率；（4）疗效与预后：30例患儿5年总体生存率为58％。胎儿型、POG／CCG III期和肿瘤完全切除患儿生存率明显提高（P＜0.05）。结论儿童晚期HB经综合治疗预后尚可。胎儿型预后较好，但肿瘤未完全切除，POG／CCG IV期及伴有远处转移尤其是肺转移患儿预后仍较差，应尽可能地早期诊断及治疗。

Analysis of survival prognostic on advanced hepatoblastoma in children

Objective To study on the prognosis of advanced hepatoblastoma （HB）in children. Methods Retrospective analysis on the clinical data of 30 with advanced hepatoblastoma cases followed up more than 3 years in 103 cases of children, from Apr. 2006 to Jul. 2014 in pediatric of Beijing Tongren hospital, capital medical university and sum up the clinical outcome and prognosis. Results （1） Clinical stage （POG/ CCG）： In 12 cases of III stage, 10 patients were complete remission（CR）, account for 83%. In 18 cases of IV stage, 8 patients were CR , account for 44%. No statistically significant difference （P = O. 08 ） between III and IV stage. （2） Serum AFP level ： In all cases, 28 cases were significantly high, account for 93%. （3） Preoperative chemotherapy： Complete resection of the tumor increased 69%. （4） Efficacy and Prognosis： In 30 cases, the 5-year over survival rate was 58%. The univariate analysis showed that factors including Fetal type , POG / CCG III, Complete resection of primary tumor could significantly increased the 5-year survival rate. Conclusions Multimodality treatment can effectively improve remission rate and prolong the survival time of children with advanced HB . Prognosis of Fetal type is good. But HB POG / CCG IV, Incomplete resection of the tumor, Distant metastasis especially in lung are highly useful in predicting poor prognosis.