44例儿童神经母细胞瘤临床分析

Clinical features of neuroblastoma: an analysis of 44 children

摘要:

目的 分析儿童神经母细胞瘤（NB）的临床特点及影响生存率的因素，为进一步优化儿童NB诊治方案提供依据。方法 以2016年4月至2020年2月收治的44例NB患儿为研究对象，回顾性分析患儿的临床资料及随访资料。结果 44例NB患儿初次就诊常见临床症状依次为发热（10/44，23%）、发现肿块（9/44，20%）、腹痛（8/44，18%）、咳嗽（7/44，16%）、面色苍白（3/44，7%）、跛行（2/44，5%）及活动异常（2/44，5%）。根据INSS分期，Ⅰ期2例（4%）、Ⅱ期5例（11%）、Ⅲ期5例（11%）、Ⅳ期32例（73%）。44例患儿平均随访时间为（15.3±1.5）个月，复发率为20%，总生存率为82%，其中无事件生存29例（66%），带瘤生存7例（16%）。病理类型为NB、血清神经元特异性烯醇化酶增高可降低NB患儿的总生存率（P < 0.05）。结论 NB患儿初诊临床症状无明显特异性，多以发热、腹痛、发现肿块最常见；初诊晚期患儿占比高；病理分型为NB、血清神经元特异性烯醇化酶增高可能与NB患儿总生存率降低有关。

Abstract:

Objective To study the clinical features of neuroblastoma (NB) and the factors influencing survival rate. Methods A total of 44 children with NB who were admitted from April 2016 to February 2020 were enrolled as research subjects. A retrospective analysis was performed on their medical data and follow-up data. Results The common clinical symptoms of these 44 children were fever (10/44, 23%), mass (9/44, 20%), abdominal pain (8/44, 18%), cough (7/44, 16%), pale complexion (3/44, 7%), claudication (2/44, 5%), and abnormal activity (2/44, 5%). According to the INSS stage, 2 children (4%) had stage I NB, 5 children (11%) had stage II NB, 5 children (11%) had stage III NB, and 32 children (73%) had stage IV NB. The mean follow-up time was (15.3±1.5) months, with a recurrence rate of 20% and an overall survival rate of 82%. Among the 44 children, 29 (66%) achieved event-free survival and 7 (16%) had survival with tumor. The univariate analysis showed that a pathological type of NB and an increase in serum neuron-specific enolase (NSE) decreased the overall survival rate of children with NB (P < 0.05). Conclusions The clinical symptoms of children with NB are not specific at the first visit. Fever, abdominal pain, and mass are common symptoms, and there is a high proportion of children in the advanced stage. The pathological type of NB and an increase in serum NSE may be associated with a reduction in the overall survival rate of children with NB.