小儿恶性肿瘤治愈后远期复发

目的：报告并讨论小儿肿瘤愈后远期复发.方法：选择小儿时期肿瘤治愈5年以后复发病例,对初发和复发肿瘤的发病年龄、肿瘤种类、复发间隔、治疗等资料进行分析.结果：共收入资料完整者7例,初治最小年龄2岁、最大7岁.复发时最小年龄11岁、最大26岁.肿瘤初发与复发间隔最短7年、最长20年.复发肿瘤包括神经母细胞瘤、恶性神经鞘瘤、肾母细胞瘤、肝母细胞瘤、胰腺囊实性瘤.7例中再次手术后死亡2例,治疗中存活4例,已经随诊1.5年至5年,另有1例确认复发后失访.结论：1）治愈后远期复发的几率不高.2）虽然间隔时间长,但复发肿瘤的基本特点与原发瘤基本一致.3）复发年龄主要在18岁以下.4）局部复发为主,可合并转移.5）远期复发后再治疗仍有治愈机会.

Late Relapse of Cured Malignant Tumor in Childhood

Objective: To report and discuss late relapse of cured malignant tumors in childhood. Methods: The enrolled patients relapsed 5 years after completion of treatment for the primary tumor. Data including age of onset,pathologic type,event-free interval and treatment were analyzed. Results: Seven cases were presented in this study. The age of onset for the initial disease ranged from 2 to 7 years old,while that of relapsed cases ranged from 11 to 26. The event-free interval ranged from 7 to 20 years. The cases included multiple types of malignancies consisting of neuroblastoma,malignant schwannoma,Wilms tumor,hepatoblastoma,and pancreatic cyst (solid tumors). Of the 7 patients,2 died after the second surgery,4 survived for 1.5 to 5 years after the second surgery while undergoing treatment or postoperative follow-up. The other patient was lost to follow-up after confirmation of the recurrence. Conclusion: Late relapse of cured malignant tumor in childhood is uncommon. Histopathology of the recurrence remains consistent with the primary tumor,although the event-free interval is quite long. The age of most patients with relapse is usually below 18. Local recurrence occurs in most of the cases,with or without metastasis. Even with recurrent disease,there remains an opportunity to cure the patient after treatment of the relapse.