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目的:探讨4期神经母细胞瘤(neuroblstoma,NB)原发肿瘤手术切除程度与生存率的关系,分析不同手术切除程度对预后的影响。方法:回顾分析2000年1月至2011年12月中山大学肿瘤防治中心收治的96例4期NB患者临床资料。根据原发灶手术切除程度将患者分为:A组:未手术或仅活检或手术切除<50%的原发肿瘤;B组:手术切除50%~90%的原发肿瘤;C组:手术切除>90%的原发肿瘤;D组:手术肉眼完全切除原发肿瘤。结果:96例4期NB患者,3年PFS和OS分别为32.8%和36.7%。A组24例,B组10例,C组23例,D组39例。A组和B组间PFS比较差异无统计学意义(P=0.352),C组和D组间PFS比较差异无统计学意义(P=0.792)。但C组+D组生存率高于A组+B组,3年PFS分别为42.2%和17.8%(P<0.001)。结论:4期NB原发肿瘤90%以上完全切除联合化疗和(或)放疗可提高生存率,少量肉眼残留或镜下残留并不影响生存率。
Objective: To investigate the relationship between the degree of surgical resection and the survival rate of 4 primary neuroblastoma (NB) patients and to analyze the effect of different degrees of resection on the prognosis. Methods: The clinical data of 96 patients with stage 4 NB treated in Sun Yat-sen University Cancer Center from January 2000 to December 2011 were retrospectively analyzed. According to the degree of resection of the primary tumor, the patients were divided into: Group A: Primary or primary tumors without surgery or biopsy or surgical resection only; Group B: Primary tumors with surgical resection of 50% -90%; Group C: Excision> 90% of the primary tumor; Group D: Surgical excision of the primary tumor completely. Results: The 3-year PFS and OS of 96 patients with stage 4 NB were 32.8% and 36.7% respectively. 24 cases in group A, 10 cases in group B, 23 cases in group C and 39 cases in group D. There was no significant difference in PFS between group A and group B (P = 0.352). There was no significant difference in PFS between group C and group D (P = 0.792). However, the survival rate of group C + D was higher than that of group A + B, and PFS was 42.2% and 17.8% respectively at 3 years (P <0.001). Conclusions: More than 90% of the 4 NB primary tumors can be completely resected combined with chemotherapy and / or radiotherapy to improve the survival rate. A small amount of macroscopic or microscopic residual disease does not affect the survival rate.