论著-头颈部
37例青少年横纹肌肉瘤的临床观察
作者:陈秀容 蔡勇君 杨 瑜 吴 晖 何鸿鸣 陈道光 陈 英 林剑扬 陈宁斌 郑艳彬 邹思平 王杰松 王 畅
所属单位:福建省肿瘤医院(福建医科大学附属肿瘤医院)肿瘤内科 (福建 福州 350014)
PDF摘要
目的 探讨青少年横纹肌肉瘤的临床疗效及预后。方法 对我院2010年1月至2017年12月收治的37 例青少年横纹肌肉 瘤患者的临床资料进行分析,包括性别、年龄、肿瘤原发部位、病理类型、分期、治疗方法、疗效及生存期。有2 例单纯手术,2例行单纯放疗,13例仅行全身化疗,20例行手术联合放化疗。化疗方案均含有长春新碱、放线菌素 D、表阿霉素、环磷酰胺等药物。单纯全身化疗的患者,行12周期VAD方案化疗。手术联合放化疗的患者,术后行6 周期的VAC方案化疗,配合局部放疗,放疗结束后再行4周期的VDC方案化疗。按照实体瘤疗效评价标准(RECIST)评 价近期客观疗效,随访。结果 男22例,女15例,年龄13至30岁,中位年龄22岁。根据美国横纹肌肉瘤研究组(IRS) 的分期标准,I期7例、Ⅱ期4例、Ⅲ期6例、Ⅳ期20例。所有患者均经病理组织活检及免疫组化确诊,胚胎型20例, 腺泡型13例,多形型4例。有2例单纯手术,2例行单纯放疗,13例仅行全身化疗,20例行手术联合放化疗。随访至 2018年3月30日,存活 9例,死亡28例。结论 青少年横纹肌肉瘤常见病理类型为胚胎型,治疗以手术、放疗、化疗 为主,但其恶性度高,死亡率高,需要多学科综合协作有望提高生存率,其预后与肿瘤分期及病理类型可能有关。
Objective To investigate the clinical efficacy and prognosis of juvenile rhabdomyosarcoma. Methods The clinical data of 37 patients with rhabdomyosarcoma admitted to our hospital from January 2010 to December 2017 were analyzed. Results There were 22 males and 15 females, ranging in age from 13 to 30 years, with a median age of 22 years. According to the staging criteria of the American rhabdomyosarcoma research group (IRS), there were 7 cases in stage I, 4 cases in stage II, 6 cases in stage III, and 20 cases in stage IV. All patients were confirmed by histopathological biopsy and immunohistochemistry. There were 20 cases of embryonal type, 13 cases of acinar type and 4 cases of pleomorphic type. There were 2 cases of simple operation, 2 cases of radiotherapy alone, 13 cases of systemic chemotherapy only, and 20 cases of surgery combined with radiotherapy and chemotherapy. Follow up to March 30, 2018, 9 cases survived and 28 died. Conclusion The common pathological type of juvenile rhabdomyosarcoma is embryonal type. It is mainly treated with surgery, radiotherapy and chemotherapy, but its malignant degree is high and the mortality is high. It is expected to improve the survival rate by multidisciplinary comprehensive cooperation. The prognosis is likely to be related to the tumor staging and pathological types.
【关键词】横纹肌肉瘤;化疗;青少年
【中图分类号】R738.6
【文献标识码】A
【DOI】10.3969/j.issn.1009-3257.2018.06.016
前言
横纹肌肉瘤(rhabdomyosarcoma,RMS)是起源于 横纹肌细胞或向横纹肌细胞分化的间叶细胞的一种恶 性肿瘤,是青少年常见的软组织肉瘤之一。国外研 究资料统计显示,横纹肌肉瘤占所有青少年恶性肿 瘤的5%~8%,男女比例为1.4~1.7:1,临床表现无特 异性,初诊时就已经为临床Ⅲ~Ⅳ期[1]。20世纪70年 代以前,治疗方法以手术切除为主,复发及转移率达 65%~80%;近年来由于手术方法的改进、化疗和放射治疗等综合治疗的应用,青少年横纹肌肉瘤患者的生 存率得到了一定程度的提高,但其总体预后仍然较 差。本文复习了我院37例青少年横纹肌肉瘤患者的临 床资料,总结该病的临床特点、治疗方法,为今后改 善青少年横纹肌肉瘤的疗效及预后提供一定的参考。
罕少疾病杂志
第25卷, 第 6 期
2019年11月
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