治疗与临床特征对墨西哥髓母细胞瘤患儿生存率的影响
Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico.
作者信息
Salceda-Rivera Violeta, Tejocote-Romero Isidoro, Osorio Diana S, Bellido-Magaña Rosalba, López-Facundo Araceli, Anaya-Aguirre Susana E, Ortiz-Morales Daniel, Rivera-Luna Roberto, Reyes-Gutiérrez Evelyne, Rivera-Gómez Rebeca, Velasco-Hidalgo Liliana, Cortés-Alva Deyanira, Lagarda-Arrechea Sandra, Arreguín-González Farina E, Benito-Reséndiz Alma E, Chávez-Gallegos Silvia, Pérez-Rivera Eloy, Gaytán-Fernández Guillermo J, León-Espitia José A, Domínguez-Sánchez Jociela, Leal-Cavazos Carlos, Simón-González Citlalli, Larios-Farak Tania C, Macías-García Nubia A, García-Espinosa Ana C, Guerrero-Maymes Francisco, Casillas-Toral Paola, González-Ramella Oscar
机构信息
Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Department of Pediatrics, Divisions of Pediatric Hematology-Oncology, Guadalajara, Jalisco, Mexico.
IMIEM, Instituto Materno Infantil del Estado de Mexico, Secretaria de Salud, Toluca, Estado de Mexico, Mexico.
出版信息
Front Oncol. 2024 May 2;14:1376574. doi: 10.3389/fonc.2024.1376574. eCollection 2024.
INTRODUCTION
Data on medulloblastoma outcomes and experiences in low- and middle-income countries, especially in Latin America, is limited. This study examines challenges in Mexico's healthcare system, focusing on assessing outcomes for children with medulloblastoma in a tertiary care setting.
METHODS
A retrospective analysis was conducted, involving 284 patients treated at 21 pediatric oncology centers in Mexico.
RESULTS
High-risk patients exhibited markedly lower event-free survival than standard-risk patients (43.5% vs. 78.3%, p<0.001). Influential factors on survival included anaplastic subtype (HR 2.4, p=0.003), metastatic disease (HR 1.9, p=0.001); residual tumor >1.5cm², and lower radiotherapy doses significantly impacted event-free survival (EFS) and overall survival (OS). Platinum-based chemotherapy showed better results compared to the ICE protocol in terms of OS and EFS, which was associated with higher toxicity. Patients under 3 years old displayed notably lower OS and EFS compared to older children (36.1% vs. 55.9%, p=0.01).
引言
关于低收入和中等收入国家，尤其是拉丁美洲髓母细胞瘤的治疗结果和经验的数据有限。本研究考察了墨西哥医疗体系中存在的挑战，重点评估了在三级医疗环境下髓母细胞瘤患儿的治疗结果。
方法
进行了一项回顾性分析，纳入了在墨西哥21家儿科肿瘤中心接受治疗的284例患者。
结果
高危患者的无事件生存率显著低于标准风险患者（43.5%对78.3%，p<0.001）。影响生存的因素包括间变性亚型（风险比2.4，p=0.003）、转移性疾病（风险比1.9，p=0.001）；残留肿瘤>1.5平方厘米，以及较低的放疗剂量对无事件生存率（EFS）和总生存率（OS）有显著影响。在总生存率和无事件生存率方面，铂类化疗与ICE方案相比显示出更好的结果，但毒性更高。3岁以下患者的总生存率和无事件生存率明显低于大龄儿童（36.1%对55.9%，p=0.01）。
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