Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Surg Today. 2012 Feb;42(3):220-4. doi: 10.1007/s00595-011-0053-0. Epub 2012 Jan 19.
The implications of surgical intervention for neuroblastomas were assessed in one institution.
We analyzed the clinical characteristics and extension of resection in 123 pediatric patients with neuroblastoma diagnosed between 1985 and 2004.
The 5-year survival rate of the 82 patients under 12 months of age, 59 of whom were treated with complete resection of the primary tumor, was 97%. The 5-year survival rate of the 41 patients over 12 months of age did not differ significantly according to whether complete (n = 19) or incomplete resection (n = 22) was performed (46 vs. 38%, respectively). No local recurrence was observed in ten patients over 12 months of age with stage 4 disease who underwent complete resection of the primary tumor; however, four of these ten patients died of metastatic recurrence.
Considering that the majority of infantile neuroblastomas in this study had favorable biology, complete resection might be unnecessary for patients under 12 years of age. For advanced neuroblastomas in patients over 12 months of age, the main treatment for metastasis is systemic chemotherapy, although extirpation of the primary tumor without extensive surgery might prevent local recurrence when combined with radiation therapy.
评估一家医疗机构中神经母细胞瘤的手术干预意义。
我们分析了 1985 年至 2004 年间诊断为神经母细胞瘤的 123 例儿科患者的临床特征和切除术范围。
82 例 12 个月以下患儿的 5 年生存率为 97%，其中 59 例患儿行肿瘤完全切除术。41 例 12 个月以上患儿的 5 年生存率与完全切除（n=19）或不完全切除（n=22）无显著差异（分别为 46%和 38%）。10 例 12 个月以上、处于 4 期的患儿行肿瘤完全切除术，未观察到局部复发，但其中 4 例患儿死于转移复发。
考虑到本研究中大多数婴儿型神经母细胞瘤具有良好的生物学特性，12 岁以下患者可能不需要完全切除。对于 12 个月以上的晚期神经母细胞瘤患者，主要治疗方法是全身化疗，尽管在联合放疗时，不进行广泛手术的原发肿瘤切除术可能预防局部复发。
