Xie Huawei, Liu Gang, Shen Zhou, Xing Guodong, Xia Qiao, Wang Xianqiang, Huang Liuming
Department of Pediatrics Surgery, The Seventh Medical Center of PLA General Hospital; National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology; Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
J Cancer Res Ther. 2022 Sep;18(5):1387-1391. doi: 10.4103/jcrt.jcrt_1992_21.
The objective of this study is to investigate the operation timing, methods, and outcome of pulmonary metastases of hepatoblastoma (HB) in children.
The clinical and follow-up data of 53 children with pulmonary metastases of HB that were admitted to our hospital from January 2012 to December 2018 were retrospectively analyzed. The pediatric patients, 36 male and 17 female, aged 13-124 months with the median age of 41 months, and all underwent routine thoracotomy.
In the 53 cases, 77 lung metastatic tumors were resected. Further, 37 patients received only one operation, 10 received two operations, 4 received 3 operations, and 2 received 4 operations. Based on Kaplan-Meier analysis, the accumulative overall survival (OS) rates at 1, 3, and 5 years were 86.8%, 69.0%, and 57.0%, respectively (median OS time: 60 months; 95% CI: 50.675-69.709 months), and accumulative EFS (vent-free survival) rates at 1, 3, and 5 years were 86.8%, 67.0%, and 55.4%, respectively (median EFS time: 59 months; 95% CI: 49.519-68.578 months). According to univariate analysis, OS was significantly altered for patients with no more than 5 nodules (p = 0.023), lung metastases without extrapulmonary metastases (p = 0.000), and laterality (p = 0.029). Gender and age (less than three years) were not significantly related to survival. According to univariate analysis, lung metastases with extrapulmonary metastases could be considered as individual factor contributing to poorer prognosis.
In this pediatric group, patients with residual nodules after chemotherapy of HB could benefit from surgical treatment, but the appropriate surgical indication of metastasectomy needs to be further investigated.
本研究旨在探讨儿童肝母细胞瘤（HB）肺转移的手术时机、方法及预后。
回顾性分析2012年1月至2018年12月我院收治的53例HB肺转移患儿的临床及随访资料。患儿年龄13 - 124个月，中位年龄41个月，男36例，女17例，均接受常规开胸手术。
53例患者共切除77个肺转移瘤。其中，37例患者仅接受1次手术，10例接受2次手术，4例接受3次手术，2例接受4次手术。根据Kaplan - Meier分析，1年、3年和5年的累积总生存率（OS）分别为86.8%、69.0%和57.0%（中位OS时间：60个月；95%CI：50.675 - 69.709个月），1年、3年和5年的累积无事件生存率（EFS，无瘤生存）分别为86.8%、67.0%和55.4%（中位EFS时间：59个月；95%CI：49.519 - 68.578个月）。单因素分析显示，结节数不超过5个（p = 0.023）、无肺外转移的肺转移（p = 0.000）及肿瘤位于单侧（p = 0.029）的患者OS有显著差异。性别和年龄（小于3岁）与生存无显著相关性。单因素分析表明，合并肺外转移的肺转移可被视为预后较差的个体因素。
在该儿童群体中，HB化疗后有残留结节的患者可从手术治疗中获益，但转移瘤切除术的合适手术指征仍需进一步研究。
