目的 比较不同化疗方案治疗肝母细胞瘤(hepatoblastoma,HB)的临床疗效。方法 分析并总结我院2007-08至2016-02收治的23例HB患儿资料,比较不同治疗方案的疗效,其中2007-08至2013-03的12例为A组,2013-03至2016-02的11例为B组。两组均采用化疗联合手术治疗方案。采用美国儿童肿瘤协会(COG)临床分期将肿瘤分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期;可早期切除肿瘤者先行手术,其余病例给予术前化疗1～3周期后再行影像学检查评估切除可能性。A组Ⅰ、Ⅱ、Ⅲ期的化疗方案为长春新碱+表阿霉素+环磷酰胺,Ⅳ期为顺铂+表阿霉素;B组Ⅰ、Ⅱ期的化疗方案为顺铂+长春新碱+氟尿嘧啶,Ⅲ、Ⅳ期为顺铂+表阿霉素。对两组资料总体及各分期两两进行疗效比较。结果 23例患儿均完整切除肿瘤。截止至随访时间(2016-02-01),A、B两组患儿无进展生存时间达1年的例数分别为5和10,其1年无进展生存率分别为41.7%和90.9%。B组1年无进展生存率高于A组(P=0.023)。A、B两组患儿总生存时间达1年的例数分别为7和10,其1年总生存率分别为58.3%和90.9%。B组1年总生存率高于A组(P=0.040),差异有统计学意义。两组资料中相同分期资料进行两两疗效比较,其结果差异无统计学意义。两组患儿均有不同程度的化疗后骨髓抑制及脏器有不良反应。结论 顺铂+表阿霉素/顺铂+长春新碱+氟尿嘧啶较长春新碱+表阿霉素+环磷酰胺治疗HB疗效较好。两组资料中分期两两比较后,与长春新碱+表阿霉素+环磷酰胺方案相比,顺铂+表阿霉素/顺铂+长春新碱+氟尿嘧啶治疗HB的疗效无明显差异;可能由于此组资料中病例数较少原因所致,但仍需进一步验证。
Abstract
Objective To study the clinical effect of different chemotherapy regimens for children with hepatoblastoma.Methods Clinical data of 23 cases with hepatoblstoma who had been treated in our hospital between August 2007 and February 2016 were summarized. Different chemotherapy regimens were used before and after March 2013. Patients were divided into Group A (12 patients treated between August 2007 and March 2013) and Group B (11 patients treated between March 2013 and February 2016). Chemotherapy combined with surgical treatment was used in both groups. According to the COG stage, patients were stratified into stageⅠ, Ⅱ, Ⅲ, Ⅳ. If feasible, partial hepatectomy(primary or delayed surgery ) was then performed, and four to six final courses were given after AFP was decreased to the normal value. Patients with stage Ⅰ, Ⅱ, Ⅲ in Group A were treated with vincristine , epirubicin and cyclophosphamide while those withstage Ⅳ were treated with cisplatin and epirubicin. In Group B, patients with stage Ⅰ, Ⅱwere treated with cisplatin, vincristine and fluorouracil, and those with stage Ⅲ, Ⅳtreated with cisplatin and epirubicin. Results Complete resection was achieved in each case of hepatoblastoma.By the cutoff date (February 1, 2016), Group B (90.9%) had a higher 1-year PFS rate than group A (41.7%) (P=0.23). Also, group B (90.9%) had a higher 1-year OS rate than group A (58.30%) (P=0.40). Patients in both groups had different degrees of bone marrow suppression after chemotherapy.Conclusion Cisplatin, epirubicin/cisplatin, vincristine and fluorouracil are more effective than vincristine, epirubicin, and cyclophosphamide for children with hepatoblastoma. There is no difference between these chemotherapy regimens, which may be due to the limited amount of data. The side effects of PLA and EPI, and PLA,VCR and 5-FU are reversible and tolerable.
关键词
肝母细胞瘤 /
化疗 /
顺铂 /
甲胎蛋白
Key words
hepatoblastoma /
chemotherapy /
cisplatin /
AFP
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Jon Pritchard, Julia Brown, Elizabeth Shafford, et al. Cisplatin, Doxorubicin, and Delayed Surgery for Childhood Hepatoblastoma: A Successful Approach—Results of the First Prospective Study of the International Society of Pediatric Oncology[J]. J Clin Oncol, 18(22),2000:3819-3828.
[2] Hishiki T, Matsunaga T, Sasaki F, et al. Outcome of hepatoblastomas treated using the Japanese Study Group for Pediatric Liver Tumor (JPLT) protocol-2: report from the JPLT[J]. Pediatr Surg Int, 2011, 27(1): 1-8.
[3] Czauderna P, Otte J B, Aronson D C, et al. Guidelines for surgical treatment of hepatoblastoma in the modern era--recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Paediatric Oncology (SIOPEL)[J]. Eur J Cancer, 2005, 41(7): 1031-1036.
[4] Exelby P R, Filler R M, Grosfeld J L. Liver tumors in children in the particular reference to hepatoblastoma and hepatocellular carcinoma: American Academy of Pediatrics Surgical Section Survey--1974[J]. J Pediatr Surg, 1975, 10(3): 329-337.
[5] Hiyama E, Ueda Y, Onitake Y, et al. A cisplatin plus pirarubicin-based JPLT2 chemotherapy for hepatoblastoma: experience and future of the Japanese Study Group for Pediatric Liver Tumor (JPLT)[J]. Pediatr Surg Int, 2013, 29(10): 1071-1075.
[6] Perilongo G, Shafford E, Maibach R, et al. Risk-adapted treatment for childhood hepatoblastoma[J]. European Journal of Cancer, 2004, 40(3): 411-421.
[7] Zsiros J, Brugieres L, Brock P, et al. Dose-dense cisplatin-based chemotherapy and surgery for children with high-risk hepatoblastoma (SIOPEL-4): a prospective, single-arm, feasibility study[J]. Lancet Oncol, 2013, 14(9): 834-842.
[8] Zsiros J, Maibach R, Shafford E, et al. Successful treatment of childhood high-risk hepatoblastoma with dose-intensive multiagent chemotherapy and surgery: final results of the SIOPEL-3HR study[J]. J Clin Oncol, 2010, 28(15): 2584-2590.
[9] Ortega J A, Douglass E C, Feusner J H, et al. Randomized comparison of cisplatin/vincristine/fluorouracil and cisplatin/continuous infusion doxorubicin for treatment of pediatric hepatoblastoma: A report from the Children’s Cancer Group and the Pediatric Oncology Group[J]. J Clin Oncol, 2000, 18(14): 2665-2675.
[10] Maibach R, Roebuck D, Brugieres L, et al. Prognostic stratification for children with hepatoblastoma: the SIOPEL experience[J]. Eur J Cancer, 2012, 48(10): 1543-1549.
[11] Qiao G L, Li L, Cheng W, et al. Predictors of survival after resection of children with hepatoblastoma: A single Asian center experience[J]. Eur J Surg Oncol, 2014, 40(11): 1533-1539.
[12] von Schweinitz D, Hecker H, Harms D, et al. Complete resection before development of drug resistance is essential for survival from advanced hepatoblastoma-a report from the German Cooperative Pediatric Liver Tumor Study HB-89[J]. J Pediatr Surg, 1995, 30(6): 845-852.
[13] Fukuzawa H, Urushihara N, Fukumoto K, et al. Can we predict the prognosis of resectable hepatoblastoma from serum alpha-fetoprotein response during preoperative chemotherapy?[J]. Pediatr Surg Int, 2012, 28(9): 887-891.
PDF(864 KB)
