Kuroda Tatsuo, Morikawa Nobuyuki, Matsuoka Kentaro, Fujino Akihiro, Honna Toshiro, Nakagawa Atsuko, Kumagai Masaaki, Masaki Hidekazu, Saeki Morihiro
Department of Surgery, National Center for Child Health and Development, Tokyo 157-8535, Japan.
J Pediatr Surg. 2008 Dec;43(12):2182-5. doi: 10.1016/j.jpedsurg.2008.08.046.
The aim of this study was to study the prognostic significance of circulating tumor cells (CTC) and the appropriate indications for aggressive surgery in advanced neuroblastoma.
Micrometastasis was sequentially explored using our reverse transcriptase-polymerase chain reaction method in 29 neuroblastoma patients (International Neuroblastoma Staging System stage 4, n = 24; stage 3, n = 5) who treated at our department with the united chemotherapeutic regimen since 1991. Their medical records and detection of CTC and/or the bone marrow micrometastasis were retrospectively reviewed then analyzed statistically.
The overall survival rate was 58.6% (17/29). Circulating tumor cells were detected in 55.6% of the stage 4 patients, and all deaths were related to systemic metastases in the CTC-positive patients. The detection of CTC scarcely associated with MYCN amplification. In the patients showing MYCN amplification but no CTC, all deaths were related to local relapse or chemotherapy-associated complications. The survival rate was not significantly different between the patients with and without MYCN amplification (56.8% vs 52.7%). However, it was significantly lower in the patients with CTC and/or persistent bone marrow micrometastasis compared to those without detectable micrometastasis (33.8% vs 87.5%; P < .05).
The presence of CTC and/or persistent micrometastasis may indicate a significantly high risk, regardless of MYCN amplification. Patients with MYCN amplification but no micrometastasis would be most benefited by highly intensive surgery.
本研究旨在探讨循环肿瘤细胞（CTC）的预后意义以及晚期神经母细胞瘤积极手术的合适指征。
自1991年起，采用我们的逆转录聚合酶链反应方法，对在我院接受联合化疗方案治疗的29例神经母细胞瘤患者（国际神经母细胞瘤分期系统4期，n = 24；3期，n = 5）进行微转移的序贯检测。回顾性分析他们的病历以及CTC和/或骨髓微转移的检测情况，并进行统计学分析。
总生存率为58.6%（17/29）。4期患者中55.6%检测到循环肿瘤细胞，CTC阳性患者的所有死亡均与全身转移有关。CTC的检测与MYCN扩增几乎无关。在显示MYCN扩增但无CTC的患者中，所有死亡均与局部复发或化疗相关并发症有关。有和没有MYCN扩增的患者生存率无显著差异（56.8%对52.7%）。然而，与无可检测微转移的患者相比，有CTC和/或持续性骨髓微转移的患者生存率显著更低（33.8%对87.5%；P < 0.05）。
无论MYCN扩增情况如何，CTC和/或持续性微转移的存在可能表明风险显著升高。MYCN扩增但无微转移的患者将从高强度手术中获益最大。
