44例儿童青少年恶性生殖细胞肿瘤综合治疗结果分析

背景与目的:目前儿童青少年恶性生殖细胞瘤采用综合治疗,总生存率已达75%以上,然而,不同分期、病理类型和发病部位的患者有不同的预后。本文分析儿童青少年恶性生殖细胞瘤的临床特点、综合治疗的效果和影响预后的因素,并探讨其治疗策略。方法:对1997年1月～2005年12月中山大学肿瘤防治中心收治的儿童青少年恶性生殖系统肿瘤患者的临床表现、综合治疗疗效和不良预后因素进行分析;采用Kaplan-Meier法计算全组生存率。结果:44例患者中,25例行术后辅助化疗;1例单纯手术;18例行诱导化疗,其中7例患者化疗后肿瘤缩小行手术切除,2例原发纵隔绒癌伴多发转移患者化疗后行残留病灶放疗,1例术后腹腔转移和1例术后肺转移患者化疗后获得完全缓解,1例原发纵隔内胚窦瘤化疗后部分缓解,未做进一步治疗,6例患者化疗无效进展死亡。化疗的患者均采用含铂类化疗方案治疗2～7个疗程。中位随访时间32个月,全组3年总生存率为84.8%;Ⅰ Ⅱ期患者3年生存率为100%,Ⅲ期为83.3%,Ⅳ期为65.6%,复发患者为66.7%;初治生殖器内(睾丸和卵巢)肿瘤患者3年生存率为96.0%,生殖器以外肿瘤患者为61.0%。结论:手术联合含铂类药物化疗能明显改善儿童青少年生殖细胞瘤的疗效和生存率,但对Ⅳ期、复发转移和生殖器以外的生殖细胞瘤患者应探讨新的方案和增加剂量强度。

Treatment outcome of children and adolescents with germ cell tumor after combined therapy---a report of 44 cases

BACKGROUND & OBJECTIVE: The overall survival rate of children and adolescents with germ cell tumor is more than 75% after adopting combined therapy. However, the prognosis varies with stage, pathologic type, and primary tumor site. This study was to analyze the clinical characteristics and treatment outcome of children and adolescents with germ cell tumor, and to investigate the prognostic factors and therapeutic strategy. METHODS: Clinical characteristics, treatment outcome, and prognostic factors of 44 children and adolescents with germ cell tumor, treated in Cancer Center of Sun Yat-sen University from Jan. 1997 to Dec. 2005, were analyzed. Survival rate was calculated by Kaplan-Meier method. RESULTS: Of the 44 patients, 25 received adjuvant chemotherapy after operation; 1 received operation alone; 18 received induction chemotherapy. Of the 18 patients, 7 received tumor resection after chemotherapy; 2 patients with primary mediastinal chorioepithelioma with multiple metastases received radiotherapy on residual disease after chemotherapy; 1 patient with postoperative abdominal metastasis and 1 with postoperative lung metastasis achieved complete remission after chemotherapy; 1 patient with mediastinal sinus tumor achieved partial remission after chemotherapy; 6 had poor response to chemotherapy and died of disease progression. Chemotherapy-treated patients received platinum-containing regimens for 2-7 cycles. The median follow-up was 32 months. The overall 3-year survival rate was 84.8%. The 3-year survival rate was 100% for stage I-II patients, 83.3% for stage III patients, 65.6% for stage IV patients, and 66.7% for relapsed patients. For previously untreated patients, the 3-year survival rate was 96.0% for gonadal germ cell tumor patients and 61.0% for extragonadal germ cell tumor patients. CONCLUSION: Surgery combined with platinum-containing chemotherapy can improve efficacy and survival of children and adolescents with germ cell tumor. For the patients with stage IV, relapsed, and metastatic tumors, novel therapeutic regimens with increased dose intensity need further investigation.