肿瘤指标和形态可预测产前诊断的骶尾部畸胎瘤预后不良：单中心 25 年经验。

Tumor metrics and morphology predict poor prognosis in prenatally diagnosed sacrococcygeal teratoma: a 25-year experience at a single institution.

机构信息

Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA.

出版信息

J Pediatr Surg. 2013 Jun;48(6):1225-31. doi: 10.1016/j.jpedsurg.2013.03.016.

DOI:10.1016/j.jpedsurg.2013.03.016

PMID:23845611

Abstract

PURPOSE

Some fetuses with sacrococcygeal teratoma (SCT) develop hydrops, but there is no consensus on an appropriate prognostic marker for poor prognosis. The purpose of this study is to establish predictors of poor prognosis in fetuses with SCT.

METHODS

A retrospective review of patients with prenatally diagnosed SCT from 1986 to 2011 was performed. Patients with outcome data and ultrasound exams before 32 weeks gestational age (GA) were included (n=37). Tumor volume-to-fetal weight ratio (TFR) and tumor morphology were assessed as sonographic predictors of poor prognosis.

RESULTS

Twelve patients (32%) had good prognosis, and twenty-five patients (68%) had poor prognosis. All patients with poor prognosis had a morphology score ≥ 3, which is a significant predictor of poor prognosis (p <0.0001). TFR was assessed, and a receiver operating characteristic (ROC) analysis identified a cutoff value of 0.12 before 24 weeks GA and 0.11 before 32 weeks GA as predictors for poor prognosis. TFR is a significant predictor of poor prognosis (p<0.0001).

CONCLUSIONS

Patients with cystic SCT all had good prognosis. TFR >0.12 was validated as a sonographic predictor of poor prognosis. TFR and tumor morphology can be used to counsel expectant families with prenatally diagnosed SCT regarding prognosis.

摘要

目的

一些骶尾部畸胎瘤（SCT）胎儿会出现水肿，但目前尚无明确的预后不良的标志物。本研究旨在确定 SCT 胎儿不良预后的预测因素。

方法

回顾性分析了 1986 年至 2011 年间产前诊断为 SCT 的患者。纳入了有结局数据和 32 孕周前超声检查的患者（n=37）。肿瘤体积与胎儿体重比（TFR）和肿瘤形态被评估为超声预测不良预后的指标。

结果

12 例（32%）患者预后良好，25 例（68%）患者预后不良。所有预后不良的患者形态评分均≥3，这是预后不良的显著预测因素（p<0.0001）。评估了 TFR，ROC 分析确定了 24 孕周前和 32 孕周前 TFR 截断值分别为 0.12 和 0.11，可作为不良预后的预测因素。TFR 是不良预后的显著预测因素（p<0.0001）。