儿童髓母细胞瘤两年内复发危险因素分析

Risk factors for recurrence within 2 years in children with medulloblastoma

摘要:

目的 探讨儿童髓母细胞瘤（MB）两年内复发的危险因素及对无进展生存（PFS）率的影响。方法 对2017年1~12月收治的123例MB患儿进行回顾性研究，根据复发与否分为复发组（n=30）和非复发组（n=93），分析影响儿童MB两年内复发的危险因素，比较不同因素间的PFS率。结果 大细胞/间变型、M分期，均为儿童MB两年内复发的危险因素。分期为M+者，其复发风险为M0的3.525倍；大细胞/间变型复发风险为经典型的3.358倍，差异有统计学意义（P < 0.05）。生存分析示分期为M+者，中位PFS期为20个月，M+、M0 20个月PFS率分别为50%±11%、81%±5%（P < 0.05）。经典型、促纤维增生/结节型、广泛结节型、大细胞/间变型20个月PFS率分别为80%±5%、65%±10%、86%±13%、36%±20%，不同病理分型之间的PFS率差异有统计学意义（P < 0.05）。结论 复发是影响儿童MB预后的重要因素，分期为M+及大细胞/间变型MB均为复发的危险因素，且PFS率更低。

Abstract:

Objective To investigate the risk factors for recurrence of medulloblastoma (MB) within 2 years and their influence on progression-free survival (PFS). Methods A retrospective analysis was performed for the clinical data of 123 children with MB who were admitted from January to December, 2017. According to the presence or absence of recurrence, they were divided into recurrence group with 30 children and non-recurrence group with 93 children. The risk factors for recurrence within 2 years were analyzed, and PFS was compared between the children with different risk factors. Results Large-cell/anaplastic type and M stage were risk factors for MB recurrence within 2 years. The risk of recurrence in the children with M+ MB was 3.525 times that in those with M0 MB, and the risk of recurrence in the children with large-cell/anaplastic MB was 3.358 times that in those with classic MB (P < 0.05). The survival analysis showed that the median PFS time was 20 months in the children with M+ MB, and the 20-month PFS rate was 50% ±11% in the children with M+ MB and 81% ±5% in those with M0 MB (P < 0.05). The 20-month PFS rate was 80% ±5% in the children with classic MB, 65% ±10% in those with desmoplastic/nodular MB, 86% ±13% in those with MB with extensible nodularity, and 36% ±20% in those with large-cell/anaplastic MB (P < 0.05). Conclusions Recurrence is an important influencing factor for the prognosis of MB, and M+ stage and large-cell/anaplastic MB are risk factors for recurrence. Children with such risk factors tend to have a low PFS rate.