Saito T, Tsunematsu Y, Saeki M, Honna T, Masaki E, Kojima Y, Miyauchi J
Division of Environmental Epidemiology at the National Children's Medical Research Center, Tokyo, Japan.
Med Pediatr Oncol. 1997 Sep;29(3):197-205. doi: 10.1002/(sici)1096-911x(199709)29:3<197::aid-mpo6>3.0.co;2-8.
To assess the progress of survival in neuroblastoma which varies with many risk factors and to evaluate the influence of these factors on survival as independent risk factors. The study subjects were 159 neuroblastoma patients seen from 1965-1994 at the oldest and largest children's hospital in Japan. Trends of survival in three treatment eras-1965-81, 1982-86, 1987-94-were assessed by the Kaplan-Meier method for different sex, age at diagnosis, the clinical stage, the site of onset, and the histological type. Then the influence on survival of these factors as independent prognostic variables was evaluated by the Cox proportional hazards regression analysis. Age at diagnosis, the clinical stage, the site of onset, the histological type, and the treatment era were independent risk factors in the order of their influence on survival. Unfavorable survival outcomes were obtained for patients with age at diagnosis above 1 year, the clinical stage of VI by the Evans classification, adrenal onset, and neuroblastoma rather than ganglioneuroblastoma. Survival improved from the first to the second and from the second to the third treatment era. Improvement of survival in neuroblastoma took place during the past 3 decades. Age at diagnosis, the clinical stage, and the histological type have still remained overwhelming prognostic factors over the progress in treatment.
评估神经母细胞瘤的生存进展（其因多种风险因素而异），并评估这些因素作为独立风险因素对生存的影响。研究对象为1965年至1994年期间在日本最古老且最大的儿童医院就诊的159例神经母细胞瘤患者。采用Kaplan-Meier法评估1965 - 1981年、1982 - 1986年、1987 - 1994年这三个治疗时期不同性别、诊断时年龄、临床分期、发病部位及组织学类型的生存趋势。然后通过Cox比例风险回归分析评估这些因素作为独立预后变量对生存的影响。诊断时年龄、临床分期、发病部位、组织学类型及治疗时期按其对生存的影响顺序为独立风险因素。诊断时年龄大于1岁、Evans分类为VI期、肾上腺发病以及为神经母细胞瘤而非节细胞神经母细胞瘤的患者生存结局不佳。从第一个治疗时期到第二个治疗时期以及从第二个治疗时期到第三个治疗时期，生存率均有所提高。在过去30年中神经母细胞瘤的生存率有所改善。诊断时年龄、临床分期及组织学类型在治疗进展过程中仍是主要的预后因素。
