摘要
目的评估儿童Ⅲ、Ⅳ期肝母细胞瘤化疗联合HIFU消融和化疗之间的疗效有无差异。方法回顾性分析2007年8月至2013年6月重庆医科大学附属儿童医院收治的30例Ⅲ、Ⅳ期肝母细胞瘤的临床资料。重新评价化疗联合HIFU消融（n=12）或化疗（n=18）后肿瘤可切除性。随访肿瘤大小，生存状况，转移及复发，甲胎蛋白等。结果化疗联合HIFU消融较化疗可以显著提高缓解率（P=0．002，确切概率法）和手术可切除率（P=0．024，确切概率法）。粒细胞减少（P=0．13）、心脏毒性和肾毒性（P=0．36）等副作用在化疗联合HIFU消融组与化疗组无差异。肿瘤反应及预后（P=0．001，确切概率法）和疾病进展（P=0．018，确切概率法）有显著统计学差异，未手术的化疗组患儿死亡率较化疗联合HIFU消融组高（P=0．001，确切概率法）；疾病复发与死亡在两种治疗方式中无明显统计学差异。化疗联合HIFu消融组治疗前后的甲胎蛋白（〉363000μg／L，0．27μg／L）及肿瘤直径（112min，27mm）；化疗组治疗前后的甲胎蛋白（〉363000μg／L，219000μg／L）及肿瘤直径（119nm，84mm）。化疗联合HIFU消融组的生存时间16～62个月，中位生存时间45个月，1年生存率100％，3年生存率83．3％，5年生存率16．7％，病死率16．7％；化疗组的中位生存时间18个月，1年生存率83．3％，3年生存5．6％，病死率55．5％。化疗联合HIFU消融可以显著提高生存率，延长生存时间。结论化疗联合HIFU治疗儿童不可切除的肝母细胞瘤显著提高缓解率和手术可切除率，延长生存期，是不可切除肿瘤患儿的较好选择。
Objective To compare the treatment outcomes of chemotherapy plus high-intensity focused ultrasound （HIFU） ablation versus chemotherapy alone in children with stages Ⅲ and Ⅳ hepatoblastoma. Methods Retrospective analyses were conducted for the clinical data of 30 cases of stages Ⅲ and Ⅳ hepatoblastoma from August 2007 to June 2013. Re-evaluation of tumor resectability after treatment was made for chemotherapy plus HIFU ablation （n = 12） versus chemotherapy （n = 18）. And follow-ups were conducted for tumor size, survival, metastasis, recurrence and alpha-fetoprotein. Results As compared with chemotherapy, chemotherapy plus HIFU ablation could significantly improve the response rate （P = 0. 002, Fishers exact test） and surgical resection rate （P = 0. 024, Fisher＇s exact test）. Neutropenia （P = 0.13）, cardiac ＆ renal toxicity （P = 0. 36） and other side effects showed no inter-group difference. Tumor response and prognosis （P = 0. 001, Fisher＇s exact test） and disease progression （P = 0. 018, Fisher＇s exact test） had significant differences. A higher mortality rate was found in chemotherapy patients without surgery than chemotherapy plus HIFU group （P = 0. 001, Fishers exact test）. Recurrence or death showed no significant inter-group difference. In chemotherapy plus HIFU ablation group, AFP before and after treatment was （〉 363,000μg/L, 0. 27 μg/L） and diameter of tumor （112 mm, 27 mm）. In chemotherapy group; AFP （〉363,000 μg/L, 219,000μg/L）, tumor diameter （119 mm, 84 mm）. For chemotherapy plus HIFU ablation group, median survival time was 45 （16-62） months, 1-year survival rate 100%, 3-year survival rate 83. 3%, 5-year survival rate 16. 7% and mortality rate 16. 7% For chemotherapy group, median survival time was 18 months, 1-year survival rate 83. 3%, 3-year survival 5.6% and mortality rate 55.5 %. Chemotherapy plus HIFU ablation could significantly improve survival rate and prolong survival time. Coneluslons Chemotherapy plus HIFU treatment may significantly improve remission rate, boost surgical resectability rate and prolong survival for children with unresectable tumor.
出处
《中华小儿外科杂志》
CSCD
2015年第1期26-31,共6页
Chinese Journal of Pediatric Surgery
基金
国家临床重点建设专科项目（国卫办医函[2013]544）
关键词
肝肿瘤
消融技术
药物疗法
联合
Liver neoplasms
Ablation techniques
Drug therapy, combination
