骶尾部畸胎瘤术后复发高危因素分析

目的 探讨和分析引起骶尾部畸胎瘤术后复发的高危因素.方法 回顾性分析2003年1月至2012年12月收治的107例骶尾部畸胎瘤患儿的临床资料,使用单因素和多因素危险度Lo-gistic回归法,从Altman分类、手术年龄、肿瘤大小、肿瘤是否完整切除、术中肿瘤是否溃破以及破溃成分、病理类型等方面分析肿瘤复发的高危因素.结果 肿瘤复发共16例,复发时间为6～59个月,平均(16.25±14.01)个月.恶性肿瘤复发均为术后常规随访发现,良性肿瘤仅2例常规随访发现,其余因出现排便困难、骶尾部出现肿块等临床症状就诊.根据Altman分类,Ⅰ～Ⅳ型的复发病例(复发率)分别为8例(15.4％)、2例(10.5％)、1例(10.0％)和5例(31.3％).病理类型中,成熟性畸胎74例中复发9例,其中5例病理性质复发后转变为未成熟或恶性畸胎瘤;未成熟畸胎瘤6例中复发2例;恶性畸胎瘤17例中复发5例.肿瘤复发后的5年生存率(64.8％)与未复发病例(95.0％)相比,差异有统计学意义(P=0.002).单因素及多因素危险度分析提示术中肿瘤实质成分溃破(P=0.028)、肿瘤残留(P=0.000)、未成熟(P=0.029)及恶性畸胎瘤(P=0.026)是骶尾部畸胎瘤复发的危险因素,而Altman分类、手术年龄、肿瘤大小以及囊液破裂并不是肿瘤复发的危险因素.结论 肿瘤复发是影响骶尾部畸胎瘤预后的重要因素.术中避免肿瘤实质成分溃破,尽可能完整切除肿瘤可减少肿瘤复发.重视骶尾部畸胎瘤,特别是成熟性畸胎瘤的术后随访,有利于尽早发现肿瘤复发,提高治愈率.

Recurring risk factors for sacrococcygeal teratoma in children

Objective To explore the recurring risk factors for sacrococcygeal teratoma (SCT)in children.Methods A retrospective review was conducted for 107 SCT children between January 2003 and December 2012 at our hospital.Risk factors were identified by univariate and multivariate analyses.Results Sixteen children had a recurrence of SCT at a median interval of 16.25 (6-59)months after primary surgery.And the Altman types of recurrent tumors were Ⅰ (n =8,15.4％),Ⅱ(n=2,10.5％),Ⅲ (n =1,10.0％) and Ⅳ (n =5,31.3％).Histologically,there were mature teratoma (n =8),immature teratoma (n =2) and malignant teratoma (n =5).Over half of recurrences showed a shift towards histological immaturity or malignancy as compared with primary tumor.The recurring risk factors were spillage of tumor parenchyma (P =0.028),incomplete resection (P =0.000) and immaturity (P =0.029) and malignant histology (P =0.026).Size,Altman classification and age were not recurring risk factors.Conclusions Tumor recurrence is an important prognostic factor for children with sacrococcygeal teratoma.The recurring risk factors include tumor spillage,malignancy or incomplete resection.Regular postoperative follow-ups are conducive for early detection of tumor recurrence and improving curative rate.