新辅助化疗治疗小儿腹部神经母细胞瘤中影像定义风险因素的变化。
Changes in image-defined risk factors with neoadjuvant chemotherapy in pediatric abdominal neuroblastoma.
机构信息
Department of Radiology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China.
Department of Pathology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, No. 136 Zhongshan Road 2, Yuzhong District, Chongqing, 400014, China.
出版信息
Abdom Radiol (NY). 2022 Oct;47(10):3520-3530. doi: 10.1007/s00261-022-03596-0. Epub 2022 Jul 5.
PURPOSE
To observe the changes in image-defined risk factors (IDRFs) with neoadjuvant chemotherapy in pediatric abdominal neuroblastoma and to investigate the correlations between IDRF changes and histopathological features. In addition, this study also investigated the correlations between residual IDRFs after neoadjuvant chemotherapy and intraoperative complications.
METHODS
Forty-three patients with abdominal neuroblastoma who received neoadjuvant chemotherapy in our hospital from January 2015 to September 2021 were enrolled. Intraoperative records, histopathological features, and CT images at initial diagnosis and after neoadjuvant chemotherapy of all patients were retrospectively collected and analyzed.
RESULTS
A total of 245 IDRFs were found at initial diagnosis, with a median of 6 [5, 7] IDRFs per patient. After neoadjuvant chemotherapy, IDRFs significantly decreased to 156 (p < 0.001), with a median of 4 [3, 5] IDRFs remaining per patient. The majority of IDRFs (6/8, 75.00%) were significantly improved after neoadjuvant chemotherapy (p < 0.05), while tumor invasion of renal pedicles (p > 0.05) and adjacent structures (p > 0.05) was the least responsive IDRF. IDRFs in different types of neuroblastoma decreased significantly after neoadjuvant chemotherapy (p < 0.05), while they were not significant in neuroblastoma with low and intermediate mitosis-karyorrhexis indices (p > 0.05). The number of residual IDRFs correlated positively with the volumes of intraoperative blood loss (r = 0.399, p = 0.008), but not with the presence of intraoperative complications (r = 0.111, p = 0.478).
CONCLUSIONS
IDRFs in different types of neuroblastoma can be significantly improved after neoadjuvant chemotherapy, while IDRFs in neuroblastoma with low and intermediate mitosis-karyorrhexis indices might not be easily improved. At the same time, the number of residual IDRFs after neoadjuvant chemotherapy might not correlate with the occurrence of intraoperative complications in abdominal neuroblastoma.
目的
观察儿童腹部神经母细胞瘤新辅助化疗后影像定义风险因素（IDRFs）的变化，并探讨 IDRF 变化与组织病理学特征之间的相关性。此外，本研究还探讨了新辅助化疗后残留 IDRFs 与术中并发症之间的相关性。
方法
回顾性收集分析 2015 年 1 月至 2021 年 9 月我院收治的 43 例接受新辅助化疗的腹部神经母细胞瘤患者的术中记录、组织病理学特征及初始诊断和新辅助化疗后的 CT 图像。
结果
初诊时共发现 245 个 IDRF，中位数为每个患者 6[5,7]个 IDRF。新辅助化疗后，IDRF 显著减少至 156 个（p<0.001），中位数为每个患者 4[3,5]个 IDRF。大多数 IDRF（6/8，75.00%）在新辅助化疗后显著改善（p<0.05），而肾蒂（p>0.05）和邻近结构（p>0.05）的肿瘤侵袭是 IDRF 改善最少的。不同类型神经母细胞瘤的 IDRF 在新辅助化疗后显著减少（p<0.05），而低和中丝裂-核碎裂指数的神经母细胞瘤则无明显变化（p>0.05）。残留 IDRF 的数量与术中出血量的体积呈正相关（r=0.399，p=0.008），但与术中并发症的发生无关（r=0.111，p=0.478）。
结论
不同类型神经母细胞瘤的 IDRF 在新辅助化疗后可显著改善，而低和中丝裂-核碎裂指数的神经母细胞瘤的 IDRF 可能不易改善。同时，新辅助化疗后残留 IDRF 的数量与腹部神经母细胞瘤术中并发症的发生无关。
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