Iehara Tomoko, Yagyu Shigeki, Tsuchiya Kunihiko, Kuwahara Yasumichi, Miyachi Mitsuru, Tajiri Tatsuro, Sugimoto Tohru, Sawada Tadashi, Hosoi Hajime
Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science Kawaramachi-Hirokoji Kamigyo-ku, Kyoto
Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science Kawaramachi-Hirokoji Kamigyo-ku, Kyoto.
Jpn J Clin Oncol. 2016 Jul;46(7):661-6. doi: 10.1093/jjco/hyw050. Epub 2016 May 20.
It remains unclear whether a residual tumor mass following therapy influences the prognosis of neuroblastoma.
We retrospectively reviewed 20 patients with intermediate-risk tumors treated at our institution between 1993 and 2012 to elucidate whether additional treatment is required for residual tumors.
The patient ages at diagnosis ranged from 0 days to 7 years. The 5-year overall survival rate was 94.4%. Thirteen patients had Stage 3 disease and seven patients had Stage 4 disease. Nine patients showed intraspinal extension. Twelve patients had a residual tumor mass at the completion of therapy, and eight showed intraspinal extension. Five of these 12 patients showed metaiodobenzylguanidine (MIBG) uptake at the end of treatment, but the uptake disappeared during the follow-up period. Except for one patient who died due to treatment complications, the rest are all alive, and nine are alive with a residual mass. We examined the residual mass in four patients and found that these tissues had differentiated into a ganglioneuroma or changed to a necrotic tissue. For the three patients with neurological symptoms at the end of treatment, some slight neurological symptoms still remained during the follow-up. Five patients with an intraspinal mass eventually presented with new symptoms.
The presence of a residual mass at the end of treatment did not influence the patients' prognosis. Therefore, an invasive radical surgical resection and additional treatment may not be necessary. Cases with a residual intraspinal mass also require a long-term follow-up to assess the neurological prognosis.The presence of a residual mass in cases of intermediate-risk neuroblastoma at the end of treatment did not influence the patients' prognosis.
治疗后残留肿瘤肿块是否会影响神经母细胞瘤的预后尚不清楚。
我们回顾性分析了1993年至2012年间在我院接受治疗的20例中危肿瘤患者，以阐明残留肿瘤是否需要额外治疗。
患者诊断时年龄从0天至7岁不等。5年总生存率为94.4%。13例患者为3期疾病，7例患者为4期疾病。9例患者出现椎管内扩展。12例患者在治疗结束时存在残留肿瘤肿块，8例出现椎管内扩展。这12例患者中有5例在治疗结束时显示间碘苄胍（MIBG）摄取，但在随访期间摄取消失。除1例因治疗并发症死亡外，其余均存活，9例有残留肿块存活。我们检查了4例患者的残留肿块，发现这些组织已分化为神经节神经瘤或变为坏死组织。对于治疗结束时出现神经症状的3例患者，随访期间仍残留一些轻微神经症状。5例有椎管内肿块的患者最终出现了新症状。
治疗结束时残留肿块的存在并未影响患者的预后。因此，可能无需进行侵入性根治性手术切除和额外治疗。有椎管内残留肿块的病例也需要长期随访以评估神经预后。中危神经母细胞瘤病例治疗结束时残留肿块的存在并未影响患者的预后。
