Chamberlain R S, Quinones R, Dinndorf P, Movassaghi N, Goodstein M, Newman K
Department of Surgery, George Washington University Medical Center, Washington, DC, USA.
Ann Surg Oncol. 1995 Mar;2(2):93-100. doi: 10.1007/BF02303622.
A multi-modality approach combining surgery with aggressive chemotherapy and radiation is used to treat advanced neuroblastoma. Despite this treatment, children with advanced disease have a 20% 2-year survival rate. Controversy has developed regarding the efficacy of combining aggressive chemotherapy with repeated surgical intervention aimed at providing a complete surgical resection (CSR) of the primary tumor and metastatic sites. Several prospective and retrospective studies have provided conflicting reports regarding the benefit of this approach on overall survival. Therefore, we evaluated the efficacy of CSR versus partial surgical resection (PSR) using a strategy combining surgery with aggressive chemotherapy, radiation, and bone marrow transplantation (BMT) for stage IV neuroblastoma.
A retrospective study was performed with review of the medical records of 52 consecutive children with neuroblastoma treated between 1985 and 1993. Twenty-eight of these 52 children presented with advanced disease, 24 of which had sufficient data to allow for analysis. All children were managed with protocols designed by the Children's Cancer Group (CCG). Statistical analysis was performed using Student's t test, chi 2 test, and Kaplan-Meier survival curves.
Mean survival (35.1 months) and progression-free survival (29.1 months) for the CSR children was statistically superior to that of the PSR children (20.36 and 16.5 months, p = 0.04 and 0.04, respectively). Similar significance was demonstrated using life table analysis of mean and progression-free survival of these two groups (p = 0.05 and < 0.01, respectively). One-, 2-, and 3-year survival rates for the CSR versus the PSR group were 100%, 80%, and 40% versus 77%, 38%, and 15%, respectively. An analysis of the BMT group compared with those children treated with aggressive conventional therapy showed improvement in mean and progression-free survival.
Aggressive surgical resection aimed at removing all gross disease is warranted for stage IV neuroblastoma. CSR is associated with prolonged mean and progression-free survival. BMT prolongs mean and progression-free survival in children with stage IV disease. These results suggest that CSR and BMT offer increased potential for long-term remission in children with advanced neuroblastoma.
多模态方法，即将手术与强化化疗及放疗相结合，用于治疗晚期神经母细胞瘤。尽管采用了这种治疗方法，但患有晚期疾病的儿童的2年生存率仍为20%。对于将强化化疗与旨在实现原发肿瘤及转移部位完整手术切除（CSR）的重复手术干预相结合的疗效，已引发了争议。几项前瞻性和回顾性研究就这种方法对总生存期的益处给出了相互矛盾的报告。因此，我们评估了采用手术联合强化化疗、放疗及骨髓移植（BMT）治疗IV期神经母细胞瘤时，完整手术切除（CSR）与部分手术切除（PSR）的疗效。
进行了一项回顾性研究，查阅了1985年至1993年间连续治疗的52例神经母细胞瘤患儿的病历。这52例患儿中有28例患有晚期疾病，其中24例有足够的数据可供分析。所有患儿均按照儿童癌症组（CCG）设计的方案进行治疗。使用学生t检验、卡方检验和Kaplan-Meier生存曲线进行统计分析。
CSR组患儿的平均生存期（35.1个月）和无进展生存期（29.1个月）在统计学上优于PSR组患儿（分别为20.36个月和16.5个月，p值分别为0.04和0.04）。对这两组患儿的平均生存期和无进展生存期进行生命表分析也显示出类似的显著性（p值分别为0.05和<0.01）。CSR组与PSR组的1年、2年和3年生存率分别为100%、80%和40%，以及77%、38%和15%。对BMT组与接受强化传统治疗的患儿进行分析表明，平均生存期和无进展生存期有所改善。
对于IV期神经母细胞瘤，进行旨在切除所有肉眼可见病灶的积极手术切除是必要的。完整手术切除（CSR）与延长平均生存期和无进展生存期相关。骨髓移植（BMT）可延长IV期疾病患儿的平均生存期和无进展生存期。这些结果表明，完整手术切除（CSR）和骨髓移植（BMT）为晚期神经母细胞瘤患儿实现长期缓解提供了更大的可能性。
