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神经母细胞瘤

Neuroblastoma.

作者信息

Nakagawara Akira, Li Yuanyuan, Izumi Hideki, Muramori Katsumi, Inada Hiroko, Nishi Masanori

机构信息

Saga Medical Center Koseikan.

Saga HIMAT Foundation, Tosu.

出版信息

Jpn J Clin Oncol. 2018 Mar 1;48(3):214-241. doi: 10.1093/jjco/hyx176.

Abstract

Neuroblastoma is one of the most common solid tumors in children and has a diverse clinical behavior that largely depends on the tumor biology. Neuroblastoma exhibits unique features, such as early age of onset, high frequency of metastatic disease at diagnosis in patients over 1 year of age and the tendency for spontaneous regression of tumors in infants. The high-risk tumors frequently have amplification of the MYCN oncogene as well as segmental chromosome alterations with poor survival. Recent advanced genomic sequencing technology has revealed that mutation of ALK, which is present in ~10% of primary tumors, often causes familial neuroblastoma with germline mutation. However, the frequency of gene mutations is relatively small and other aberrations, such as epigenetic abnormalities, have also been proposed. The risk-stratified therapy was introduced by the Japan Neuroblastoma Study Group (JNBSG), which is now moving to the Neuroblastoma Committee of Japan Children's Cancer Group (JCCG). Several clinical studies have facilitated the reduction of therapy for children with low-risk neuroblastoma disease and the significant improvement of cure rates for patients with intermediate-risk as well as high-risk disease. Therapy for patients with high-risk disease includes intensive induction chemotherapy and myeloablative chemotherapy, followed by the treatment of minimal residual disease using differentiation therapy and immunotherapy. The JCCG aims for better cures and long-term quality of life for children with cancer by facilitating new approaches targeting novel driver proteins, genetic pathways and the tumor microenvironment.

摘要

神经母细胞瘤是儿童最常见的实体瘤之一,具有多样的临床行为,这在很大程度上取决于肿瘤生物学特性。神经母细胞瘤具有独特的特征,如发病年龄早、1岁以上患者诊断时转移性疾病发生率高以及婴儿肿瘤有自发消退的倾向。高危肿瘤常伴有MYCN癌基因扩增以及节段性染色体改变,生存率低。最近先进的基因组测序技术显示,约10%的原发性肿瘤中存在的ALK突变常导致伴有种系突变的家族性神经母细胞瘤。然而,基因突变的频率相对较小,并且也有人提出了其他异常情况,如表观遗传异常。日本神经母细胞瘤研究组(JNBSG)引入了风险分层治疗,该组织现正并入日本儿童癌症组(JCCG)的神经母细胞瘤委员会。多项临床研究推动了低危神经母细胞瘤患儿治疗方案的简化,以及中危和高危疾病患者治愈率的显著提高。高危疾病患者的治疗包括强化诱导化疗和清髓性化疗,随后使用分化疗法和免疫疗法治疗微小残留病。JCCG旨在通过推动针对新型驱动蛋白、遗传通路和肿瘤微环境的新方法,为癌症患儿实现更好的治愈效果和长期生活质量。

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