切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (04) : 242 -246. doi: 10.3877/cma.j.issn.2095-9141.2021.04.010

临床研究

儿童髓母细胞瘤的风险分层治疗
陈立华1, 孙恺1, 陈文锦1, 夏勇1, 张洪钿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:2020-10-26 出版日期:2021-08-11
  • 通信作者: 徐如祥
  • 基金资助:
    四川省科学技术厅重点研发项目(2021YFS0010)

Risk stratification treatment of medulloblastoma in children

Lihua Chen1, Kai Sun1, Wenjin Chen1, Yong Xia1, Hongtian Zhang1, Ruxiang Xu1,()   

  1. 1. Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, China
  • Received:2020-10-26 Published:2021-08-11
  • Corresponding author: Ruxiang Xu
引用本文:

陈立华, 孙恺, 陈文锦, 夏勇, 张洪钿, 徐如祥. 儿童髓母细胞瘤的风险分层治疗[J]. 中华神经创伤外科电子杂志, 2021, 07(04): 242-246.

Lihua Chen, Kai Sun, Wenjin Chen, Yong Xia, Hongtian Zhang, Ruxiang Xu. Risk stratification treatment of medulloblastoma in children[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(04): 242-246.

目的

总结儿童髓母细胞瘤(MDB)分层治疗的经验,探索MDB风险分级对预后的影响。

方法

回顾性分析2011年1月至2019年12月由笔者进行分层治疗的32例MDB患儿的临床资料。根据风险分级标准,将32例MDB患儿分为低危、标危、高危和极高危4组,分析肿瘤风险分级与预后的关系。

结果

32例MDB患儿平均随访时间为47个月(33~91个月),5年总生存率(OS)和无进展生存率(PFS)分别为57.3%±7.2%和68.7%±8.6%。低危组的OS和PFS明显高于高危组,标危组明显高于极高危组,差异均具有统计学意义(P<0.05)。

结论

根据MDB的风险分级标准制定分层治疗方案,有利于预测预后和提高MDB治疗的生存率和改善生存质量。

Objective

To summarize the stratified treatment experience in children with medulloblastoma (MDB), and to explore the effect of risk classification of pediatric MDB on prognosis.

Methods

The clinical data of 32 children with MDB treated by stratification from January 2011 to December 2019 were analyzed retrospectively. According to the standard of risk classification, 32 children with MDB were divided into four groups: low risk, standard risk, high risk and extremely high risk. The relationship between tumor risk classification and prognosis was analyzed.

Results

The average follow-up time of 32 cases was 47 months (33-91 months). The 5-year overall survival rate (OS) and progression-free survival (PFS) were 57.3%±7.2% and 68.7%±8.6%, respectively. The OS and PFS in the low risk group were significantly higher than those in the high risk group, and were significantly higher in the standard risk group than in the extremely high risk group, and the differences have statistical significance (P<0.05).

Conclusion

Developing hierarchical treatment plans under the standard of risk classification criteria of MDB, it is beneficial to predict the prognosis, improve the survival rate and quality of life for MDB treatment.

表1 分子分型与危险度分级
表2 风险分层与治疗方案的制定
表3 32例髓母细胞瘤患儿5年OS和PFS分析
[1]
Hoff KV, Hinkes B, Gerber NU, et al. Long-term outcome and clinical prognostic factors in children with medulloblastoma treated in the prospective randomised multicentre trial HIT’91[J]. Eur J Cancer, 2009, 45(7): 1209-1217.
[2]
Chang CH, Housepian EM, Herbert C Jr. An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas[J]. Radiology, 1969, 93(6): 1351-1359.
[3]
Ramaswamy V, Remke M, Bouffet E, et al. Risk stratification of childhood medulloblastoma in the molecular era: the current consensus[J]. Acta Neuropathol, 2016, 131(6): 821-831.
[4]
Jiang T, Zhang Y, Wang J, et al. Impact of tumor location and fourth ventricle infiltration in medulloblastoma[J]. Acta Neurochir (Wien), 2016, 158(6): 1187-1195.
[5]
Bokun J, Grujicic D, Skender-Gazibara M, et al. Management and treatment of children with medulloblastoma in Serbia, a middle-income country[J]. J BUON, 2018, 23(4): 1156-1162.
[6]
Rutkowski S, von Hoff K, Emser A, et al. Survival and prognostic factors of early childhood medulloblastoma: an international meta-analysis[J]. J Clin Oncol, 2010, 28(33): 4961-4968.
[7]
Gajjar A, Chintagumpala M, Ashley D, et al. Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicentre trial[J]. Lancet Oncol, 2006, 7(10): 813-820.
[8]
Ellison DW, Kocak M, Dalton J, et al. Definition of disease-risk stratification groups in childhood medulloblastoma using combined clinical, pathologic, and molecular variables[J]. J Clin Oncol, 2011, 29(11): 1400-1407.
[9]
Taylor MD, Northcott PA, Korshunov A, et al. Molecular subgroups of medulloblastoma: the current consensus[J]. Acta Neuropathol, 2012, 123(4): 465-472.
[10]
Tarbell NJ, Friedman H, Polkinghorn WR, et al. High-risk medulloblastoma: a pediatric oncology group randomized trial of chemotherapy before or after radiation therapy (POG 9031)[J]. J Clin Oncol, 2013, 31(23): 2936-2941.
[11]
Gandola L, Massimino M, Cefalo G, et al. Hyperfractionated accelerated radiotherapy in the milan strategy for metastatic medulloblastoma[J]. J Clin Oncol, 2009, 27(4): 566-571.
[12]
Hovestadt V, Smith KS, Bihannic L, et al. Resolving medulloblastoma cellular architecture by single-cell genomics[J]. Nature, 2019, 572(7767): 74-79.
[13]
Neumann JE, Swartling FJ, Schüller U. Medulloblastoma: experimental models and reality[J]. Acta Neuropathol, 2017, 134(5): 679-689.
[14]
Kumar V, Kumar V, McGuire T, et al. Challenges and recent advances in medulloblastoma therapy[J]. Trends Pharmacol Sci, 2017, 38(12): 1061-1084.
[15]
Hammoud H, Saker Z, Harati H, et al. Drug repurposing in medulloblastoma: challenges and recommendations[J]. Curr Treat Options Oncol, 2020, 22(1): 6.
[1] 傅强, 熊颖, 宋可馨, 闫妍, 刘昊. ACR-TIRADS、EU-TIRADS及KTA/KSThR-TIRADS评估甲状腺结节一致性的研究[J]. 中华医学超声杂志(电子版), 2020, 17(07): 684-690.
[2] 徐雯, 李文波, 朱庆莉, 张青, 姜玉新. 美国甲状腺协会指南甲状腺结节超声分类系统的临床应用价值[J]. 中华医学超声杂志(电子版), 2017, 14(07): 526-531.
[3] 云望, 乔卫东, 李钢. 髓母细胞瘤显微手术切除[J]. 中华神经创伤外科电子杂志, 2021, 07(05): 318-320.
[4] 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.
[5] 陈立华, 孙恺, 陈文锦, 夏勇, 张洪钿, 徐如祥. 髓母细胞瘤的临床特征与手术入路选择[J]. 中华脑科疾病与康复杂志(电子版), 2021, 11(01): 41-47.
[6] 陈立华, 陈文锦, 夏勇, 张洪钿, 孙恺, 徐如祥. 髓母细胞瘤的手术入路选择[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 298-304.
[7] 陈立华, 孙恺, 陈文锦, 夏勇, 张洪钿, 徐如祥. 髓母细胞瘤的分期和分型的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(05): 293-297.
[8] 陈立华, 孙恺, 陈文锦, 夏勇, 张洪钿, 徐如祥. 髓母细胞瘤的流行病学特征和预后[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(04): 239-243.
[9] 陈立华, 孙恺, 陈文锦, 夏勇, 张洪钿, 徐如祥. 儿童髓母细胞瘤的显微手术治疗[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(04): 197-204.
[10] 陈立华. 积极开展髓母细胞瘤分子分型的研究[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(04): 193-196.
[11] 王欣欣, 陈小燕. 多学科协作的新理念——肥胖症的分层管理[J]. 中华肥胖与代谢病电子杂志, 2017, 03(01): 7-11.
阅读次数
全文


摘要