Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
Department of Pediatric Surgery, Shandong Dezhou People's Hospital, Shandong, China.
J Pediatr Surg. 2019 Dec;54(12):2585-2588. doi: 10.1016/j.jpedsurg.2019.08.031. Epub 2019 Aug 30.
Stage 4S neuroblastoma is a unique category of metastatic disease in infants with a favorable outlook. The purpose of this study was to clarify the prognostic factors of patients with stage 4S neuroblastoma.
Data were retrospectively collected from infant patients with stage 4S neuroblastoma in our department from May 2000 to May 2018. Patient characteristics, operative variables, perioperative outcomes, overall survival (OS), and recurrence were evaluated. Univariate and multivariate analyses were performed to identify the prognostic factors of stage 4S neuroblastoma.
A total of 28 infant patients (71. 4% males) with a mean age of 3.7 ± 2.7 months were recruited. The involved metastatic sites included liver (n = 18), skin (n = 9), and bone marrow (n = 5). Nine patients received biopsy, and 14 patients underwent original lesions resection followed by postchemotherapy. Five patients accompanied with abdominal compartment syndrome (ACS) were given experiential chemotherapy. The follow-up time ranged from 12 M to 156 M, with a mean of 32 months. Twenty-two patients completed treatment and survived. Two patients were still under treatment. Four patients died, including three with ACS. No recurrence was observed. According to Kaplan-Meier method, the 5-year overall survival was 84.4%. ACS (p = 0.001) and chemotherapy sensitivity (p < 0.001) were associated with all causes of mortality of stage 4S neuroblastoma, while neuroblastoma liver metastasis (P = 0.107), skin metastasis (P = 0.137), bone marrow metastasis (P = 0.89), tumor radical resection (P = 0.202), prenatal diagnosis (P = 0.314), and younger than 2 months of age (P = 0.683) did not emerge as prognostic factors.
ACS and chemotherapy sensitivity were highly important factors that had an association with the prognosis of stage 4S neuroblastoma.
Prognosis study.
Level IV.
4S 期神经母细胞瘤是婴儿期具有良好预后的独特转移性疾病类别。本研究旨在阐明 4S 期神经母细胞瘤患者的预后因素。
本研究回顾性收集了 2000 年 5 月至 2018 年 5 月我科收治的 4S 期神经母细胞瘤婴儿患者的数据。评估了患者特征、手术变量、围手术期结果、总生存（OS）和复发情况。采用单因素和多因素分析确定 4S 期神经母细胞瘤的预后因素。
共纳入 28 例婴儿患者（71.4%为男性），平均年龄为 3.7±2.7 个月。转移灶部位包括肝（n=18）、皮肤（n=9）和骨髓（n=5）。9 例患者行活检，14 例行原发病灶切除，术后行化疗。5 例伴有腹腔间隔室综合征（ACS）的患者给予经验性化疗。随访时间为 12-156 个月，平均 32 个月。22 例患者完成治疗并存活。2 例仍在治疗中。4 例死亡，其中 3 例死于 ACS。无复发。根据 Kaplan-Meier 法，5 年总生存率为 84.4%。ACS（p=0.001）和化疗敏感性（p<0.001）与 4S 期神经母细胞瘤的所有死因相关，而神经母细胞瘤肝转移（P=0.107）、皮肤转移（P=0.137）、骨髓转移（P=0.89）、肿瘤根治性切除（P=0.202）、产前诊断（P=0.314）和年龄小于 2 个月（P=0.683）均未成为预后因素。
ACS 和化疗敏感性是与 4S 期神经母细胞瘤预后密切相关的重要因素。
预后研究。
IV 级。
