DeCou J M, Bowman L C, Rao B N, Santana V M, Furman W L, Luo X, Lobe T E, Kumar M
Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
J Pediatr Surg. 1995 Jul;30(7):937-40; discussion 940-1. doi: 10.1016/0022-3468(95)90316-x.
Although infants (age less than 1 year) with neuroblastoma have a favorable overall prognosis, metastatic disease is associated with poorer treatment outcome. To assess the role of surgery in these patients, the authors reviewed survival data for 151 infants treated for neuroblastoma, focusing on patient and tumor characteristics, biological markers, and surgical management among the 99 patients with metastatic disease. Patients were divided into early (1961 to 1978) and contemporary (1979 to 1993) treatment eras. Potential prognostic factors were statistically tested to determine their significance in affecting survival. Five-year survival by Pediatric Oncology Group stage was: A, 100% (+/- 0%); B, 94% (+/- 6%); DS, 77% (+/- 9%); C, 73% (+/- 9%); and D, 61% (+/- 8%). Survival for infants with metastatic disease (stages C, D, and DS) was affected significantly by treatment era (P = .0001). Analyses restricted to patients treated during the contemporary era showed prognostic significance for DNA index (P = .02), N-myc copy number (P = .007), serum lactate dehydrogenase level (P = .001), and extent of resection (P = .01). A > or = 95% resection of the primary tumor was found to be associated with improved survival. Significantly more surgical complications were associated with resections performed at the time of diagnosis (P = .007), and delaying surgery until after several courses of chemotherapy did not decrease survival. In conclusion, multiple factors affect the outcome of treatment for infants with metastatic neuroblastoma, and whenever feasible, a > or = 95% resection of the primary tumor should be performed in this patient subgroup.
虽然患有神经母细胞瘤的婴儿（年龄小于1岁）总体预后良好，但转移性疾病与较差的治疗结果相关。为了评估手术在这些患者中的作用，作者回顾了151例接受神经母细胞瘤治疗的婴儿的生存数据，重点关注99例患有转移性疾病患者的患者和肿瘤特征、生物标志物及手术治疗情况。患者被分为早期（1961年至1978年）和当代（1979年至1993年）治疗时代。对潜在的预后因素进行统计学检验，以确定它们在影响生存方面的意义。按儿童肿瘤学组分期的5年生存率为：A期，100%（±0%）；B期，94%（±6%）；DS期，77%（±9%）；C期，73%（±9%）；D期，61%（±8%）。转移性疾病（C期、D期和DS期）婴儿的生存受治疗时代的影响显著（P = 0.0001）。仅对当代治疗时代接受治疗的患者进行的分析显示，DNA指数（P = 0.02）、N - myc拷贝数（P = 0.007）、血清乳酸脱氢酶水平（P = 0.001）和切除范围（P = 0.01）具有预后意义。发现原发肿瘤切除率≥95%与生存率提高相关。诊断时进行的切除相关的手术并发症明显更多（P = 0.007），并且将手术推迟到几个疗程的化疗之后并没有降低生存率。总之，多种因素影响转移性神经母细胞瘤婴儿的治疗结果，并且只要可行，在该患者亚组中应进行原发肿瘤切除率≥95%的手术。
