The Retrospective Analysis Of 45 Cases Of Rhabdomyosarcoma In Children

Objective:Rhabdomyosarcoma(RMS)is the most common soft tissue sarcoma in children.It is a high malignancy with insidious onset invasive fast-growing,and lack of specificity in clinical manifestations.Moreover,it grows rapidly,and is easy to metastasis and relapse in early stage,with high malignancy and poor prognosis.The purpose of this study is to review the clinical data of 45 cases of rhabdomyosarcoma in our hospital in the past 7 years,and analyze the clinical characteristics and prognostic factors of rhabdomyosarcoma through a single center study,so as to provide more theoretical reference for the diagnosis,treatment and prognosis of rhabdomyosarcoma in children.Methods:The clinical data of 45 children with rhabdomyosarcoma admitted to Qilu Hospital of Shandong University from February 2010 to December 2017 were collected,including basic clinical data,treatment process information,follow-up and prognosis survival analysis.The clinical characteristics,diagnosis and treatment of the children were analyzed retrospectively,and the prognosis related factors of the children were studied in a single center.SPSS 17.0 software was used to establish the database for statistical analysis.The measurement data that do not conform to normal distribution are represented by median and interquartile spacing.Frequency and composition ratio were used to express the counting data.Chi-square test or Fisher exact probability method was used to analyze the difference between groups.The survival time and 95%confidence interval were calculated statistically.P<0.05 was statistically significant.Life table method was used to analyze the survival rate and mortality.Kaplan Meier method was used to draw the survival curve.Log-rank test was used to compare the difference of survival time among different groups,and single factor analysis of survival time was carried out.The test level was ?=0.05.Results:1.General clinical conditions and pathological classification:gender statistics includes 24 boys and 21 girls,with a male to female ratio of 1.14:1;the age of onset is from 3 months to 204 months,with a median age of 60 months,with an average age of 78.6 months,including 7 cases of age ?1 year,25 cases of age 1-10 years,and 13 cases of age>10 years.There are two types of pathological diagnosis:embryonal type and acinar type,38 embryonal rhabdomyosarcoma and 7 acinar rhabdomyosarcoma.There was no significant difference in pathological types of different gender and age groups(P>0.05)2.Location and metastasis of tumor:12 cases were primary in head and neck;11 cases in urogenital system;10 cases in limbs;7 cases in abdomen:5 cases in others(including 1 case in mediastinum,1 case in right waist,1 case in buttock,1 case in groin and 1 case in front of sacrum).The first three locations were head and neck,urogenital system and limbs.As of the follow-up date,14 of 45 RMS patients had no metastasis,7 had local metastasis,14 had regional metastasis and 10 had distant metastasis3.Clinical stage and risk group:according to the postoperative pathological clinical group system of the intergroup RMS study group(IRSG),there are 3 cases in stage ?,11 cases in stage ?,8 cases in stage ? and 23 cases in stage ?;the risk group is 3 cases in the low-risk group,18 cases in the middle-risk group and 24 cases in the high-risk group,and most of the children are in the middle-risk group at the time of diagnosis(93.33%)4.Follow up data and survival status:as of May 2018,18 patients who chose to give up the treatment had died,with a total survival period of 13 months at most;27 children who chose to be treated,9 patients received surgery,4 patients received chemotherapy,13 patients received surgery combined with chemotherapy,1 patient received surgery combined with radiotherapy and chemotherapy,5 patients died at the end of the follow-up period,one year,two years,three years The four-year survival rates were 54%,54%,42%and 42%,respectively.The analysis of survival function showed that the fastest decline of cumulative survival rate was 0-1 year after treatment,especially within 6 months after treatment,and the decline trend tended to be flat after 1 year.5.Single factor analysis results:Log rank test was used to compare the difference of survival time among different clinical information groups and to analyze the prognostic factors.The results showed that there was no significant difference in the influence of gender,age of onset and location of onset on the survival time of RMS children(P>0.05);whether the tumor had metastasis,TNM stage,clinical grouping,surgical resection and the choice of treatment mode on the survival of RMS children The difference of survival time was statistically significant(P<0.001).Conclusion:1.In this study,gender,age of onset and location of onset did not affect prognosis,which was related to small sample size,low early visit rate and grouping difference.2.There is no significant correlation between pathological classification and prognosis.In this study,the proportion of acinar rhabdomyosarcoma is small,and it can not be completely determined that there is no difference between the total survival rate of acinar rhabdomyosarcoma and embryonal rhabdomyosarcoma.Large sample of acinar rhabdomyosarcoma cases are needed to be verified.Moreover,most of the children with rhabdomyosarcoma are distributed in the middle and high risk groups,once distant metastasis occurs,there is no difference.The prognosis of all pathological types is poor.3.Tumor metastasis,TNM stage and clinical grouping significantly affect the prognosis of RMS.RMS in children has the characteristics of low early treatment rate,easy to transfer,rapid progress,etc.clinical understanding of its early performance is often insufficient,resulting in delayed diagnosis and treatment.The prognosis of RMS patients with tumor metastasis,stage ?,stage ? and medium high risk is poor.For these patients,early detection,early treatment and standardized treatment should be carried out to improve the prognosis.4.Whether or not surgical resection is significantly related to the prognosis of RMS children.For patients with limited tumors,surgical treatment can completely remove without recurrence;for those who cannot completely remove surgery,the prognosis is poor.For these children,a higher intensity comprehensive treatment scheme suitable for individual characteristics can be adopted to improve the prognosis.5.Whether to accept the treatment or not and the choice of treatment mode are significantly related to the prognosis of children with RMS.In this study,those who give up the treatment had died,while those in the high-risk group could achieve complete remission through comprehensive treatment.Children with RMS should be actively treated,and the survival time of those who choose the comprehensive treatment is significantly longer,and the comprehensive treatment has better curative effect and prognosis.Early detection and standardized treatment play an important role in improving the long-term survival rate of rhabdomyosarcoma in children.