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101例儿童复发髓母细胞瘤的序贯治疗生存分析
Survival of children with recurrent medulloblastoma undergoing sequential therapy: an analysis of 101 cases
目的 分析儿童复发髓母细胞瘤（MB）的临床特征，并探讨进一步治疗方案。方法 回顾性分析2011年8月至2017年7月该院收治的101例复发MB患儿的临床资料，随访截至2020年7月31日。采用Kaplan-Meier法进行生存分析，Cox回归模型进行多因素回归分析。结果 95例患儿给予诱导缓解治疗，51例有效，有效率54%。复发后中位总体生存（OS）期13个月，1年、3年、5年OS率分别为50.5%±5.0%、19.8%±4.0%、10%±3.3%。 < 3岁与3~18岁、不同性别、不同病理分型、不同Change分期、复发前是否放疗、复发后是否二次放疗、手术至复发 < 12个月与≥12个月各组患儿5年OS率比较差异均无统计学意义（P > 0.05）；复发后是否二次手术、复发于不同部位MB患儿的5年OS率比较差异均有统计学意义（P < 0.05）。复发后二次手术者OS期显著长于未手术者（P=0.007），其中复发后二次手术患儿的死亡风险为复发后未手术者的0.389倍（95% CI：0.196~0.774）。结论 MB一旦复发，虽经再次诱导缓解治疗可获缓解，但OS期仍短，仅二次手术可显著延长OS期，故有条件可考虑早期进行二次手术以改善患儿预后。
Objective To study the clinical features of children with recurrent medulloblastoma (MB) and treatment regimens. Methods A retrospective analysis was performed on 101 children with recurrent MB who were admitted to the hospital from August 1, 2011 to July 31, 2017. The children were followed up to July 31, 2020. The Kaplan-Meier method was used for survival analysis. The Cox regression model was used for multivariate regression analysis. Results Of the 101 children, 95 underwent remission induction therapy, among whom 51 had response, resulting in a response rate of 54%. The median overall survival (OS) time after recurrence was 13 months, and the 1-, 3-, and 5-year OS rates were 50.5%±5.0%, 19.8%±4.0%, and 10%±3.3% respectively. There was no significant difference in the 5-year OS rate between the children with different ages (< 3 years or 3-18 years), sexes, pathological types, or Change stages, between the children with or without radiotherapy before recurrence or re-irradiation after recurrence, and between the children with different times to recurrence (< 12 months or ≥ 12 months after surgery) (P > 0.05). There were significant differences in the 5-year OS rate between the children with or without reoperation after recurrence and between the children with different recurrence sites (P < 0.05). The children with reoperation after recurrence had a significantly longer survival time than those without reoperation (P=0.007), and the risk of death in children undergoing reoperation after recurrence was 0.389 times (95% confidence interval:0.196-0.774) that in children who did not undergo such reoperation. Conclusions As for the recurrence of MB, although remission induction therapy again can achieve remission, such children still have a short survival time. Only reoperation can significantly prolong survival time, and therefore, early reoperation can be considered to improve the outcome of children with recurrent MB.
Medulloblastoma / Recurrence / Treatment / Reoperation / Child
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北京市医院管理中心儿科学科协同发展中心专项经费资助（XTYB201816）。
