【摘要】 目的:分析肝母细胞瘤(hepatoblastoma, HB)患儿的临床特征、治疗效果及预后影响因素。方法:回顾性分析2019年1月至2023年11月就诊于湖南省儿童医院和湖南中医药大学第一附属医院的132例HB患儿的临床资料，采用Kaplan-Meier法绘制生存曲线，Log-rank检验进行单因素生存分析，将单因素分析中差异具有统计学意义的因素纳入COX回归模型进行多因素分析，确定影响HB患儿总生存率(overall survival, OS)预后的独立危险因素。结果:入组患儿中位年龄18.5月，男性占60.61%;PRETEXT Ⅱ/Ⅲ期占80.30%,高危组65.15%,上皮型病理86.36%,单发肿瘤86.36%,V/P/EF/R阳性率31.82%。中位随访31个月；1、3年的OS分别为98.5%、77.4%,1、3年的无事件生存率(event-free survival, EFS)为95.0%、77.8%。HB患儿完全缓解88例，部分缓解12例，治疗有效率75.76%(100/132),进展14例，死亡18例。PRETEXT分期、病理分型、肿瘤个数、V/P/EF/R是否阳性、甲胎蛋白(alpha-fetoprotein, AFP)水平、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio, PLR)及危险度分层均与HB预后有关(P<0.05);病理分型为混合型、AFP水平>300 000μg/L、NLR≥2是HB预后的独立危险因素(P<0.05)。结论:病理分型为混合型、极高AFP水平及NLR升高是影响HB的独立预测指标。更多还原

【Abstract】 Objective:To analyze the clinical features,treatment effect and prognostic factors of children with hepatoblastoma(HB).Methods:The clinical data of 132 children with HB admitted to Hunan Children’s Hospital and the First Hospital of Hunan University of Chinese Medicine from January 2019 to November 2023 were retrospectively analyzed.The survival curve was drawn by Kaplan-Meier method,and the Log-rank test was used for univariate survival analysis.The factors with statistically significant differences in univariate analysis were included in the COX regression model for multivariate analysis to determine the independent risk factors affecting the overall survival(OS) of children with HB.Results:The median age of the enrolled children was 18.5 months,and males accounted for 60.61%.PRETEXT stage Ⅱ/Ⅲ accounted for 80.30%,high-risk group 65.15%,epithelial type 86.36%,single tumor 86.36%,V/P/EF/R positive 31.82%.The median follow-up time was 31 months.The 1-and 3-year OS rates were 98.5%and 77.4%,respectively,and the 1-and 3-year event-free survival(EFS) rates were 95.0% and 77.8%.In HB children,88 cases achieved complete remission,12 cases achieved partial remission,and the effective rate was 75.76%(100/132).14 cases progressed,and 18 cases died.PRETEXT stage,pathological type,tumor number,V/P/EF/R positive or not,alpha-fetoprotein(AFP) level,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR) and stratification of risk were all related to HB prognosis(P<0.05).Mixed pathological type,AFP level>300 000 μg/L and NLR≥2 were independent risk factors for the prognosis of HB(P<0.05).Conclusion:Mixed pathological type,extremely high AFP level and elevated NLR are independent predictors of HB.更多还原