高危神经母细胞瘤强化治疗方案中的外科问题

作     者：Cantos M.F. Gerstle J.T. Irwin M.S. P.C.W. Kim 李丹 

作者机构：Division of General Surgery The Hospital for Sick Children Toronto Ont. M5G 1X8 Canada 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2006年第2卷第A10期

页      面：42-42页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：神经母细胞瘤 并发症率 儿童肿瘤 组织学检查 肿瘤标记物 围手术期 肿瘤来源 剂量方案 复发率 术后 

摘      要：Background: High- risk neuroblastoma (NB; age, 1 year; INSS stage 4) is associated with a poor outcome. At our institution, the current dose- intensive high- risk Children’ s Oncology Group protocol for advanced NB appears to have a higher surgical complication rate as compared with previous protocols. Methods: All stage 4 patients (n = 51) entered in high- risk protocols between 1995 and 2005 were analyzed. Patients in the current high- risk protocol, Children’ s Oncology Group A3973 (n = 22), were compared with those in the 2 previous protocols, CCG 3891 and POG 9341 (n = 29). Results: Patients were comparable in their mean age and tumor markers, including Shimada histology, MYCN amplification, 1p deletion, tumor origin, and extent of metastasis. However, transfusion requirement (86% vs 45% ; P = 0.0019), postoperative infection rate (32% vs 3% ; P = 0.02), and other postoperative issues including nutritional support (45% vs 3% ; P = 0.0001) were significantly higher with the current protocol. No perioperative mortality was noted in either group, and the extent of resectability and margins were similar. Importantly, with the current protocol, the survival rate was higher (P = 0.0022) and the recurrence rate was significantly lower (P = 0.0003). Conclusions: Despite higher surgical morbidity associated with the current high- risk protocol (2.59 vs 0.86 complications/person; P 0.01), the recurrence rate is lower and interim survival rate is improved for patients with high- risk NB. Therefore, the higher surgical complication rates associated with the current high- risk protocol are acceptable.