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中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (04) : 221 -226. doi: 10.3877/cma.j.issn.2095-123X.2021.04.007

临床研究

儿童髓母细胞瘤的个体化治疗及预后相关因素分析
陈立华1, 孙恺1, 夏勇1, 魏帆1, 黄宏志1, 徐如祥1,()   
  1. 1. 610072 成都,四川省医学科学院·四川省人民医院神经外科
  • 收稿日期:2021-05-09 出版日期:2021-08-15
  • 通信作者: 徐如祥

Individualized treatment of medulloblastoma in children and analysis of prognostic factors

Lihua Chen1, Kai Sun1, Yong Xia1, Fan Wei1, Hongzhi Huang1, Ruxiang Xu1,()   

  1. 1. Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, China
  • Received:2021-05-09 Published:2021-08-15
  • Corresponding author: Ruxiang Xu
引用本文:

陈立华, 孙恺, 夏勇, 魏帆, 黄宏志, 徐如祥. 儿童髓母细胞瘤的个体化治疗及预后相关因素分析[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(04): 221-226.

Lihua Chen, Kai Sun, Yong Xia, Fan Wei, Hongzhi Huang, Ruxiang Xu. Individualized treatment of medulloblastoma in children and analysis of prognostic factors[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(04): 221-226.

目的

探索儿童髓母细胞瘤(MDB)的风险分级和分层治疗对预后的影响。

方法

回顾性分析自2011年1月至2019年12月由笔者行经小脑延髓裂入路显微手术治疗的32例MDB患儿的临床资料。根据风险分层标准,将MDB分为低危、中危和高危组,分析治疗模式、风险分级与预后的关系。

结果

本组MDB患儿中肿瘤全切除和近全切除29例,全切除和近全切除率为90.6%,次全切除3例,无手术相关死亡病例,无永久性脑脊液漏。随访时间6~84个月,32例MDB患儿的3年总生存率(OS)为96.9%,5年OS为84.4%。低危组3年、5年OS明显优于高危组,中危组5年OS为91.7%,高危组5年OS仅63.6%。手术后联合化学治疗(ChT)+放射治疗(RT)的综合治疗模式的患儿5年OS为95.5%,单纯手术治疗的效果最差,患儿3年OS仅66.7%(2/3)。

结论

根据MDB的危险分级制定个体化的治疗方案,有利于提高MDB治疗的生存率和改善生存质量。术后联合ChT+RT对改善MDB预后有重要意义。

Objective

To explore the impact of risk grading and stratified treatment of children with medulloblastoma (MDB) on the prognosis.

Methods

A retrospective analysis of the clinical data of 32 children with MDB treated by microsurgery through the cerebellar medulla oblongata approach admitted by the author from January 2011 to December 2019 was retrospectively analyzed. According to risk stratification criteria, MDB was divided into low-risk, intermediate-risk and high-risk groups, and the relationship between treatment mode, risk classification and prognosis was analyzed.

Results

There were 29 cases of total resection and near total resection, and the rate of total resection and near total resection was 90.6%; 3 cases were subtotal resection. There were no deaths related to surgery and no permanent cerebrospinal fluid leakage. The follow-up time was 6-84 months, the 3-year overall survival (OS) rate was 96.9%, and the 5-year OS rate was 84.4%. The 3-year and 5-year OS rate of the low-risk group was significantly better than that of the high-risk group. The 5-year OS rate of the intermediate-risk group was 91.7%, and the 5-year OS rate of the high-risk group was only 63.6%. The combined 5-year OS rate of combined chemotherapy (ChT) and radiotherapy RT after surgery was 95.5%, and surgery alone had the worst effect, with a 3-year OS rate of only 66.7%.

Conclusion

According to the risk classification of MDB, an individualized treatment plan is helpful to increase the survival rate of MDB treatment and improve the quality of life. Combining RT and ChT after surgery is of great significance to improve the prognosis.

表1 MDB临床风险分级
表2 风险分层与治疗方案的制定
表3 风险分级与肿瘤切除程度[例(%)]
表4 32例髓母细胞瘤患儿影响预后的因素分析[例(%)]
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