| Kejun He,Zhen Tan,Xiaojun Yuan. Treatment results of childhood extracranial malignant germ cell tumors and the salvage approach for recurrent and refractory cases: a single-center report. Oncol Transl Med, 2019, 5: 229-236. |
| 儿童颅外恶性生殖细胞肿瘤的综合治疗结局分析 |
| Treatment results of childhood extracranial malignant germ cell tumors and the salvage approach for recurrent and refractory cases: a single-center report |
| Received:May 29, 2019 Revised:November 21, 2019 |
| DOI：10.1007/s10330-019-0362-2 |
| 中文关键词: 化疗，生殖细胞肿瘤，手术，放疗，儿童 |
| 英文关键词: chemotherapy; germ cell tumor; radiotherapy; surgery; children |
| 基金项目: |
| Author Name | Affiliation | Department | | Kejun He | Department of Pediatric Hematology/Oncology, Xinhua Hospital AffiliatedBeginEttoEndETShanghai Jiao Tong University School of Medicine, Shanghai 200092, China | Department of Pediatric Hematology/Oncology | | Zhen Tan | Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine | Department of Pediatric Hematology/Oncology | | Xiaojun Yuan* | Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine | Department of Pediatric Hematology/Oncology |
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| 中文摘要: |
| 目的：儿童生殖细胞肿瘤大多结局良好，但也有约10%左右的病例为复发难治性病例，需要较强烈的治疗手段挽救。本研究的目的在于(1)研究目前手术和JEB化疗方案对颅外恶性生殖细胞肿瘤的治疗效果；（2）统计分析本中心复发、难治性恶性生殖细胞肿瘤的挽救治疗效果。
方法：2007年1月至2015年12月期间，共纳入本中心收治的颅外恶性生殖细胞肿瘤58例，以及复发、难治的恶性生殖细胞肿瘤14例进入挽救方案。以 Kaplan-Meier方法进行生存统计，通过双侧log-rank检验比较组间生存率，通过多因素回归模型分析各因素对生存的影响。
结果：初始治疗包括手术治疗，JEB方案（卡铂、依托泊苷、博来霉素）化疗。挽救策略包括多种化疗药物组成的二线化疗方案，放射治疗以及二次手术。5年无事件和总体生存率分别为74.1±5.7% 和 86.2±4.5%。对于25例复发/难治性病例，至随访结束时有17例仍生存，5年无事件和总体生存率分别为48.0±10.0% 和 67.8±9.4%。对生存结局的单因素分析中，我们发现是否接受局部放射治疗对生存结局具有显著性的影响(77.4±10.0% vs 42.9±18.7%, P=0.045) ，Cox回归模型提示未能接受二次手术完全切除残余/复发病灶者的生存期限显著缩短。
结论：在手术完全切除原发病灶和以铂类药物化疗的基础上，儿童生殖细胞肿瘤预后良好。本研究发现，对于复发/难治病例，若能通过术前、术后的放射治疗以及二次手术切除病灶达到良好的局部控制，将有希望达到长期生存的目标。 |
| 英文摘要: |
| Objective The aim of this study is to report the treatment result of childhood excranial malignant germ cell
tumors and discuss the experience for recurrent and refractory cases treatment from our center.
Methods We have retrospectively analyzed 58 extracranial malignant germ cell tumor patients treated with
surgery and chemotherapy from our center over a 9-year period. Another 14 recurrent and refractory cases
referred from other centers were added to the study for salvage approach. We evaluated the treatment
results for primary cases and relapsed cases with a median follow-up of 61.5 months. Several factors were
analysed to evaluate their power to the outcome of these cases.
Results The 5-year event-free and overall survival for primary cases were 74.1±5.7% and 86.2±4.5%,
respectively. 25 recurrent or refractory cases entered the salvage approach study, and 17 patients were
alive till the end of follow-up. We demonstrated superior survival outcome for those with successful local
control through pre-operative and post-operative radiotherapy, second-look surgery and multi-drug secondline chemotherapies.
Conclusion The outcome for childhood extracranial malignant germ cell tumors is generally favorable.
For recurrent and refractory cases, multi-modality treatment approaches including radiotherapy, salvage
chemotherapy and secondlook surgery are important for better local control. |
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