Le Tourneau J N, Bernard J L, Hendren W H, Carcassonne M
J Pediatr Surg. 1985 Jun;20(3):244-9. doi: 10.1016/s0022-3468(85)80113-5.
The role of surgery for children with neuroblastoma was evaluated by using a recently proposed TNM staging system. One-hundred thirty patients were retrospectively assigned a TNM clinical stage (CS) preoperatively and a pathologic stage (PS) postoperatively. Patients with CS 4 were separated into CS 4A and CS 4B according to their age and pattern of metastases. Patient survival was analyzed according to CS, age, location of primary, and PS. Actuarial survival of patients was as follows: CS 1, 100%; CS 2, 82%; CS 3, 63%; CS 4A, 50%; and CS 4B, 5%. For all stages, patients younger than 1 year old survived longer than those older than 1 year (72% v 32%). Prognosis for CS 1 was the same regardless of age. For CS 2 and CS 3, patients younger than 1 year old lived longer. CS 4A had better survival than CS 4B. Survival by site was 100% for cervical, 62% for mediastinal, 45% for pelvic, and 36% for retroperitoneal primaries. The role of surgery was evaluated by analyzing survival according to the postoperative PS. PS 1-2-3 A were regarded as satisfactory resections since all macroscopic tumor was removed. PS 3B as a debulking procedure, and PS 3C as an unresectable lesion which was biopsied. Patients with nonmetastatic disease (CS 1-3) with PS 1 and PS 2 disease had a 100% survival rate; PS 3A, 93%; PS 3B, 58%; and PS 3C, 21%. This proves the value of total resection in nonmetastatic disease. The role of surgery could also be proven in metastatic disease.(ABSTRACT TRUNCATED AT 250 WORDS)
采用最近提出的TNM分期系统评估手术在神经母细胞瘤患儿治疗中的作用。对130例患者进行回顾性分析，术前确定TNM临床分期（CS），术后确定病理分期（PS）。CS 4期患者根据年龄和转移模式分为CS 4A和CS 4B。根据CS、年龄、原发灶位置和PS分析患者生存率。患者的精算生存率如下：CS 1期，100%；CS 2期，82%；CS 3期，63%；CS 4A期，50%；CS 4B期，5%。所有分期中，1岁以下患者的生存期长于1岁以上患者（72%对32%）。CS 1期患者的预后与年龄无关。CS 2期和CS 3期患者中，1岁以下患者生存期更长。CS 4A期的生存率高于CS 4B期。按原发灶部位统计的生存率为：颈部100%，纵隔62%，盆腔45%，腹膜后原发灶36%。通过分析术后PS的生存率来评估手术的作用。PS 1-2-3A被视为满意切除，因为所有肉眼可见肿瘤均被切除。PS 3B为减瘤手术，PS 3C为不可切除病变且仅做活检。非转移性疾病（CS 1-3）患者中，PS 1和PS 2疾病患者的生存率为100%；PS 3A为93%；PS 3B为58%；PS 3C为21%。这证明了在非转移性疾病中全切除的价值。手术在转移性疾病中的作用也得到了证实。（摘要截选至250字）
