术前化疗对肝母细胞瘤手术及预后的影响

目的评价术前化疗对肝母细胞瘤（hepatoblastoma，HB）手术切除率及预后的影响。方法将1993。2004年80例HB患儿分为两大组。术前化疗组（A组）48例，其中PRETEXTⅠ期13例，Ⅱ期13例，Ⅲ期15例，Ⅳ期7例。Ⅰ、Ⅱ期均采用弱方案化疗，Ⅲ、Ⅳ期分别采用强方案（A1组）及弱方案（A2组）化疗，Ⅲ期病例中，A1组6例，A2组9例；Ⅳ期病例中，A1组3例，A2组4例。术前未化疗组（B组）32例，1期12例，Ⅱ期9例，Ⅲ期6例，Ⅳ期5例。两组年龄、性别、病理分期与分型、手术及术后治疗和随诊，均符合统计学可比性要求。A，组化疗使用阿霉素、顺铂3—6轮，A2组使用长春新碱、环磷酰胺、阿霉素1～2轮。比较A（A1、A2）组、B组手术切除率、5年生存率及围术期死亡率。结果随访60—200个月，Ⅰ、Ⅱ期A组与B组手术切除率和5年生存率差异无统计学意义（P〉0．05）。Ⅲ、Ⅳ期病例合并后比较，A2组、B组手术切除率和5年生存率差异无统计学意义（P〉0．05）；A1与B组、A1组与（A2＋B）组手术切除率差异有统计学意义（P〈0．05）。手术完整切除者5年存活率明显高于手术未切除者，差异有统计学意义（P〈0．01）。结论术前化疗对PRETEXTⅠ、Ⅱ期患儿手术切除率和5年生存率无意义，术前强方案足疗程化疗可提高PRETEXTⅢ、Ⅳ期病例手术切除率，术前弱方案短疗程化疗及术前不化疗，不能提高PRETEXTⅢ、Ⅳ期手术切除率。手术完整切除者5年生存率达90％。

Preoperative chemotherapy improves the removal and survival of hepatoblastoma

Objective To assess the efficacy of preoperative chemotherapy on the tumor respectability and prognosis in hepatoblastoma （HB）. Methods A retrospective study was conducted on 80 eases of HB who were divided into 2 groups according to whether they received preoperative chemotherapy （group A,48 cases）or not （group B,32 cases ）.Two different chemotherapy programs were used in group A,and patients in group A were divided again into 2 sub-groups according to whether they received the intensive program including a combination of cisplatin（CDDP）and doxorubicin,given 3 to 6 courses（sub-group A1,9 patients including 6 in PRETEXT Ⅲ and 3 in IV ）or the mild program including vincristine,cyclophosphamide,doxorubiein or tetrahydropyranyl- adriamycin,given 1 or to courses （sub-group A2 39 patients including 13 in PRETEXT 1,13 in Ⅱ,9 in Ⅲ and 4 in Ⅳ）.Among the patients in group B,12 cases were in PRETEXT 1,9 in Ⅱ,6 in Ⅲ and 5 in IV.The tumor removal rate,5-year survival rate and perioperative mortality were compared between groups. Results The baseline conditions in groups were comparable on age,gender,pathological grouping and staging, operative technology,postoperative managements and duration of follow up.All patients were followed up at duration of 60 months to 200 months.The tumor removal rate and 5-year survival rats were not significant different between the sub-group A2 and the group B （P 〉 0.05,with or without patients in PRETEXT Ⅲ and Ⅳ）,and significant different between the sub-group A 1 and the group B （P 〈 0.05 ）,as well as significant different between the sub-group A 1 and the combination of sub-group A2 and group B （P 〈 0.05 ）.When the tumor removed totally,the 5-year survival rate was obviously improved compared with whose tumor removed incompletely（P 〈 0.01 ）. Conclusions The preoperative chemotherapy does not improve the tumor removal rate or 5-year survival rate for patients in PRETEXT I and R.The intensive program with adequate courses can improve the tumor removal rate for patients in PRETEXT Ⅲ and Ⅳ,while the mild program can not.The 5-year survival rate in total tumor resection is 90%.