2024 年第 10 期 第 19 卷

不同术前新辅助化疗方案应用于高危神经母细胞瘤的效果对比研究

Comparative study on the efficacy of different preoperative neoadjuvant chemotherapy regimens in high-risk neuroblastoma

作者：田聪1席红卫2

英文作者：Tian Cong1 Xi Hongwei2

单位：1山西医科大学儿科医学系，太原030001；2山西省儿童医院普外科，太原030001

英文单位：1Department of Pediatric Medicine Shanxi Medical University Taiyuan 030001 China; 2Department of General Surgery Shanxi Children′s Hospital Taiyuan 030001 China

关键词：高危神经母细胞瘤；新辅助化疗；手术切除；生存率

英文关键词：High-riskneuroblastoma;Neoadjuvantchemotherapy;Surgicalresection;Survivalrate

• 摘要：

• 目的 对比不同术前新辅助化疗方案应用于高危神经母细胞瘤(HR-NB)的效果。方法 收集2016年1月至2019年1月于山西省儿童医院诊治的50例HR-NB患儿的临床资料进行回顾性分析。根据术前新辅助化疗方案的不同分为A组（30例）和B组（20例）。A组术前采用CAV（环磷酰胺+阿霉素+长春新碱）与CVP（环磷酰胺+依托泊苷+顺铂）方案交叉化疗；B组术前采用CAV（药物同A组）与VIP（依托泊苷+异环磷酰胺+顺铂）方案交叉化疗。对比2组化疗效果、手术完整切除率、不良反应及生存情况。结果 B组化疗有效率明显高于A组［90.0%（18/20）比63.3%（19/30）］，差异有统计学意义（P<0.05）。B组与A组手术完整切除率差异无统计学意义［85.0%（17/20）比63.3%（19/30）］（P=0.148）。2组患儿耐受均良好，B组白细胞减少、血小板降低、呕吐腹泻及肝肾功能受损发生率均低于A组，差异均有统计学意义（均P<0.05）。Kaplan-Meier生存分析结果显示B组3年总体生存率高于A组，差异有统计学意义（67.2%比49.9%，Log-rank χ2=3.986，P=0.046）。结论 术前CAV与VIP交替化疗方案应用于HR-NB患儿可能效果较好，不良反应可耐受。

• Objective To compare the efficacy of different preoperative neoadjuvant chemotherapy regimens in high-risk neuroblastoma (HR-NB). Methods The clinical data of 50 children with HR-NB diagnosed and treated in Shanxi Children′s Hospital from January 2016 to January 2019 were collected and retrospectively analyzed. Patients were divided into group A (30 cases) and group B (20 cases) according to different preoperative neoadjuvant chemotherapy regimens. Group A was treated with CAV (cyclophosphamide+adriamycin+vincristine) and CVP (cyclophosphamide+etoposide+cisplatin) before surgery. Group B was treated with CAV (the same drug as group A) and VIP (etoposide+ifosfamide+cisplatin) chemotherapy before surgery. The chemotherapy effect, complete resection rate, adverse reactions and survival were compared between the two groups. Results The effective rate of chemotherapy in group B was significantly higher than that in group A［90.0%(18/20) vs 63.3%(19/30)］(P<0.05). There was no significant difference in the complete resection rate between group B and group A ［85.0%(17/20) vs 63.3%(19/30)］(P=0.148). The children in both groups tolerated well. The incidences of leukopenia, thrombocytopenia, vomiting, diarrhea, and liver and kidney function damage in group B were lower than those in group A (all P<0.05). Kaplan-meier survival analysis showed that the 3-year overall survival rate in group B was higher than that in group A (67.2% vs 49.9%, Log-rank χ2=3.986， P=0.046）. Conclusions Preoperative CAV and VIP alternating chemotherapy regimen may be effective in children with HR-NB, and the adverse reactions can be tolerated.