| ObjectiveTo summarize the diagnosis and treatment data of advanced(stage ?/?)neuroblastoma in children in a single center for 15 years.Aanalyzing the clinical data,treatment methods,long-term survival,survival rate and prognostic factors of the cases.And to provide clinical suggestions for improving the treatment of advanced neuroblastoma in children.MethodsChildren with neuroblastoma treated in Pediatrics Department of the PLA General Hospital from January 2001 to December 31 2015 were selected as the subjects.The deadline for the study was December 31 2017.A total of 146 children with NB were collected.Among them,57 cases were lost to follow-up,3 cases were treated with out-of-hospital chemotherapy(without COG regimen),6 cases were INSS stage ? and IVs,and 4 cases without pathological or cytomyelological diagnosis.At last,76 NB children of stage III and IV with definite survival time were followed up,and they were included in this study.The clinical data and treatment methods of advanced NB children were summarized and analyzed by retrospective study.Long-term survival was followed up.Survival rate and prognostic factors were counted.Result1.Among 76 children with advanced neuroblastoma(stage ?/?),40 were male(52.6%)and 36 were female(47.4%).The ratio of male to female was 1.1:1.The age of onset ranged from 7 months to 11 years,of which 4 cases(5.3%)were 0-1 years old,49 cases(64.5%)were 1-5 years old and 23 cases(30.2%)were over 5 years old.Staging:17 cases(22.4%)were stage ? and 59 cases(77.6%)were stage IV.Chemotherapy was administered in all cases,61 children(80.3%)underwent surgery and 19 children(25.0%)accepted radiotherapy.40(52.6%)children with NB underwent hematopoietic stem cell transplantation and biotherapy.The average survival time of all NB patients was 72.2±8.9 months.The overall 5-year survival rate(OS)was 36.9%.2.The average survival time of stage ? NB children was 96.3±17.7 months,and that of stage ? was 63.5±9.3 months.The survival time of stage ? children was longer than that of stage IV children,but there was no significant difference in the overall survival rate between the two groups(Log rank ?2=2.280,P=0.131).3.The average survival time of NB children who underwent surgery was 81.6 ± 9.7 months,and that of non-surgical children was 11.6±2.2 months.The survival time of patients undergoing operation was longer than that of patients without operation.The difference of total survival rate between the two groups was statistically significant(Log rank?2=27.524,P<0.001)4.The mean survival time of NB patients treated with radiotherapy was 86.6±17.3 months,and that of non-radiotherapy patients was 61.6±8.8 months.The survival time of the radiotherapy group was longer than that of the non-radiotherapy group,but there was no significant difference in the overall survival rate between the two groups(Log rank?2=1.659,P=0.198)5.The mean survival time of NB patients receiving stem cell transplantation was 104.9±11.6 months,and that of NB patients without stem cell transplantation was 21.6±4.7 months.The difference of total survival rate between the two groups was statistically significant(Log rank ?2=37.221,P<0.001).6.The average survival time of NB children treated with biotherapy was 104.9± 11.6 months,and that of children without biotherapy was 21.6±4.7 months.The survival time of the biological treatment group was longer than that of the non-biological treatment group,the difference of total survival rate between the two groups was statistically significant(Log rank ?2=37.221,P<0.001).Conclusion1.In our study,the overall 5-year survival rate(OS)of 76 patients with stage ?/?neuroblastoma was 36.9%.2.At present,chemotherapy,surgery,autologous hematopoietic stem cell transplantation,local radiotherapy and biotherapy should be taken to improve the curative effect of stage III/IV NB.3.Surgical treatment can improve the prognosis of children with advanced NB significantly(P<0.001).Excision of the primary lesion and reduction of tumor burden are of great significance for follow-up treatment and delaying the development of the disease.4.The survival time of 40 children who received stem cell transplantation and biotherapy was longer than those who did not receive stem cell transplantation and biotherapy.Hematopoietic stem cell transplantation and biotherapy can effectively improve the prognosis of children with advanced NB(P<0.001).5.The most common recurrence sites in NB children are the primary site and bone/bone marrow,and attention should be paid to the treatment of these sites. |
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