101例儿童复发髓母细胞瘤的序贯治疗生存分析

Survival of children with recurrent medulloblastoma undergoing sequential therapy:an analysis of 101 cases

摘要:

目的 分析儿童复发髓母细胞瘤（MB）的临床特征，并探讨进一步治疗方案。方法 回顾性分析2011年8月至2017年7月该院收治的101例复发MB患儿的临床资料，随访截至2020年7月31日。采用Kaplan-Meier法进行生存分析，Cox回归模型进行多因素回归分析。结果 95例患儿给予诱导缓解治疗，51例有效，有效率54%。复发后中位总体生存（OS）期13个月，1年、3年、5年OS率分别为50.5%±5.0%、19.8%±4.0%、10%±3.3%。 < 3岁与3~18岁、不同性别、不同病理分型、不同Change分期、复发前是否放疗、复发后是否二次放疗、手术至复发 < 12个月与≥12个月各组患儿5年OS率比较差异均无统计学意义（P > 0.05）；复发后是否二次手术、复发于不同部位MB患儿的5年OS率比较差异均有统计学意义（P < 0.05）。复发后二次手术者OS期显著长于未手术者（P=0.007），其中复发后二次手术患儿的死亡风险为复发后未手术者的0.389倍（95% CI：0.196~0.774）。结论 MB一旦复发，虽经再次诱导缓解治疗可获缓解，但OS期仍短，仅二次手术可显著延长OS期，故有条件可考虑早期进行二次手术以改善患儿预后。

Abstract:

Objective To study the clinical features of children with recurrent medulloblastoma(MB)and treatment regimens.Methods A retrospective analysis was performed on 101 children with recurrent MB who were admitted to the hospital from August 1,2011 to July 31,2017.The children were followed up to July 31,2020.The Kaplan-Meier method was used for survival analysis.The Cox regression model was used for multivariate regression analysis.Results Of the 101 children,95 underwent remission induction therapy,among whom 51 had response,resulting in a response rate of 54%.The median overall survival(OS)time after recurrence was 13 months,and the 1-,3-,and 5-year OS rates were 50.5%±5.0%,19.8%±4.0%,and 10%±3.3%respectively.There was no significant difference in the 5-year OS rate between the children with different ages(<3 years or 3-18 years),sexes,pathological types,or Change stages,between the children with or without radiotherapy before recurrence or re-irradiation after recurrence,and between the children with different times to recurrence(<12 months or≥12 months after surgery)(P>0.05).There were significant differences in the 5-year OS rate between the children with or without reoperation after recurrence and between the children with different recurrence sites(P<0.05).The children with reoperation after recurrence had a significantly longer survival time than those without reoperation(P=0.007),and the risk of death in children undergoing reoperation after recurrence was 0.389 times(95%confidence interval:0.196-0.774)that in children who did not undergo such reoperation.Conclusions As for the recurrence of MB,although remission induction therapy again can achieve remission,such children still have a short survival time.Only reoperation can significantly prolong survival time,and therefore,early reoperation can be considered to improve the outcome of children with recurrent MB.