Voglino Valerio, Persano Giorgio, Crocoli Alessandro, Castellano Aurora, Serra Annalisa, Giordano Ugo, Natali Gian Luigi, Di Paolo Pier Luigi, Martucci Cristina, Stracuzzi Alessandra, Inserra Alessandro
Surgical Oncology-General and Thoracic Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Onco-Hematology Unit, Department of Onco-Hematology and Gene Therapy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Front Pediatr. 2021 Nov 16;9:761896. doi: 10.3389/fped.2021.761896. eCollection 2021.
Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications during induction chemotherapy. To find easily and rapidly assessed parameters that help clinicians identify those patients affected by high-risk neuroblastoma who have an additional risk of hemorrhagic complications. The clinical notes of patients diagnosed with high-risk neuroblastoma from January 2013 until February 2021 were retrospectively reviewed. Clinical, demographic and laboratory data, biological characteristics of the tumor, and information about treatment and hospital stay were identified. In the examined period, 44 patients were diagnosed with high-risk neuroblastoma. Four of these patients had hemorrhagic complications within 2-7 days after the initiation of induction chemotherapy; two patients had hemothorax, one patient had hemoperitoneum and one patient had hemothorax and hemoperitoneum. The patient with isolated hemoperitoneum was treated with blood components transfusions, clotting factors and colloids infusions; the three patients with hemothorax underwent thoracostomy tube placement and respiratory support. At initial presentation, patients who suffered from hemorrhagic complications had a higher degree of hypertension (stage 2, = 0.0003), higher levels of LDH (median 3,745 U/L, = 0.009) and lower levels of hemoglobin (mean 7.6 gr/dl, = 0.0007) compared to other high-risk patients. A subgroup of "additional" high-risk patients can be identified within the high-risk neuroblastoma patients based on mean arterial pressure, LDH levels and hemoglobin levels at presentation. Further studies to define cut-off values and optimal management strategies for these patients are needed.
神经母细胞瘤是儿童最常见的实体颅外肿瘤。根据无事件生存期和总生存期，神经母细胞瘤患者被分为低危、中危和高危。一些高危患者在诱导化疗期间有发生急性出血性并发症的额外风险。为了找到易于快速评估的参数，以帮助临床医生识别那些患有高危神经母细胞瘤且有出血性并发症额外风险的患者。对2013年1月至2021年2月期间诊断为高危神经母细胞瘤的患者临床记录进行回顾性分析。确定了临床、人口统计学和实验室数据、肿瘤的生物学特征以及治疗和住院信息。在研究期间，44例患者被诊断为高危神经母细胞瘤。其中4例患者在诱导化疗开始后2 - 7天内出现出血性并发症；2例患者发生血胸，1例患者发生腹腔积血，1例患者同时发生血胸和腹腔积血。单纯腹腔积血的患者接受了血液成分输血、凝血因子和胶体输注治疗；3例血胸患者进行了胸腔闭式引流管置入和呼吸支持。在初次就诊时，与其他高危患者相比，发生出血性并发症的患者高血压程度更高（2期，P = 0.0003），乳酸脱氢酶（LDH）水平更高（中位数3745 U/L，P = 0.009），血红蛋白水平更低（平均7.6 gr/dl，P = 0.0007）。根据就诊时的平均动脉压、LDH水平和血红蛋白水平，可在高危神经母细胞瘤患者中识别出一组“额外”的高危患者。需要进一步研究来确定这些患者的临界值和最佳管理策略。
