PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析*

doi:10.3969/j.issn.1672-5069.2018.04.005

实用肝脏病杂志 ›› 2018, Vol. 21 ›› Issue (4): 505-508.doi: 10.3969/j.issn.1672-5069.2018.04.005

PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析^*

张财源, 李金凝, 刘欢欢, 汪登斌

200092上海市上海交通大学医学院附属新华医院放射科

收稿日期:2018-05-10 出版日期:2018-07-10 发布日期:2018-07-12
通讯作者: 汪登斌,E-mail:wangdengbin@xinhuamed.com.cn
作者简介:张财源,男,38岁,医学博士,主治医师,从事腹部影像学诊断研究
基金资助:
*科技部国家重点研发计划项目（编号：2017YFC0109003）

Application of PRETEXT staging system in evaluating treatment response of children with hepatoblastoma

Zhang Caiyuan, Li Jinning, Liu Huanhuan, et al

Department of Radiology, Xinhua Hospital, Jiaotong University School of Medicine, Shanghai 200092, China

Received:2018-05-10 Online:2018-07-10 Published:2018-07-12

摘要/Abstract

摘要： 目的探讨儿童肝母细胞瘤（HB）PRETEXT分期系统和CT征象在疗效评估中的应用价值。方法 2013年1月~2016年8月经组织病理学检查确诊的47例HB患儿,回顾性分析其CT检查资料,以术后组织病理学检查结果为参照,分析术前PRETEXT分期系统的正确性,并分析不同病理学分型患儿肿瘤边界、形态、出血、钙化和囊变坏死程度等CT征象的异同。结果本组单纯上皮型30例（63.8%）,上皮与间叶混合型17例（36.2%）;8例直接手术患儿术前PRETEXT分期6例为II期,2例为III期,均与术后病理学诊断分期相符,39例化疗后手术患儿术前和术后PRETEXT分期准确率为79.5%（31/39）;在47例患儿中,术前PRETEXTCT分期与术后病理学判定比,其准确率达83.0%（39/47）;钙化多见于上皮与间叶混合型,本组病例中MDCT显示10例出现钙化,其中上皮与间叶混合型者8例,显著多于单纯上皮型（x²=8.313,P=0.004）。结论 PRETEXT术前和术后分期诊断HB患儿的准确率较高,结合特征性CT征象可提示组织病理学分型,为HB临床决策提供较为可靠的依据。

关键词: 肝母细胞瘤, 儿童, PRETEXT分期, 计算机X线体层摄影术

Abstract: Objective To evaluate the value of PRETEXT staging system and CT imaging features in evaluating treatment response of pediatric hepatoblastoma （HB）. Methods The multi-detector CT imaging features in 47 children with pathologically confirmed HB were retrospectively reviewed between January 2013 and August 2016. The consistency between PRETEXT stage and post-surgical pathological grade was assessed. The CT imaging findings, including tumor margin,morphology,intra-tumor hemorrhage,calcification and intra-tumor cystic necrosis, and pathological grades was evaluated. Results Out of 47 children with HB,30（63.8%） were pathological-proven epithelial,and 17（36.2%） with epithelial-mesenchymal type;eight children with HB,including 6 with PRETEXT stage II and 2 with PRETEXT stage III, received surgery without chemotherapy,and their PRETEXT stages was completely consistent with pathological-proven grade, and the accuracy rate between POSTTEXT stages and pathological grades reached 79.5% （31/39） in 39 children receiving surgery after chemotherapy;the overall accuracy of PRETEXT stage was 83.0% as compared with post-surgical pathological grade;out of ten children with tumor calcification,eight was with epithelial-mesenchymal type tumor, much higher than in with epithelial type （x²=8.313,P=0.004）. Conclusion The PRETEXT stage is well consistent with post-surgical grade, and it might predict the pathological grade in consideration of specific image findings,which is helpful in determining management strategy of children with HB.

Key words: Hepatoblastoma, Children, PRETEXT staging system, X-ray computed tomography

张财源, 李金凝, 刘欢欢, 汪登斌. PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析^*[J]. 实用肝脏病杂志, 2018, 21(4): 505-508.

Zhang Caiyuan, Li Jinning, Liu Huanhuan, et al. Application of PRETEXT staging system in evaluating treatment response of children with hepatoblastoma[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(4): 505-508.

参考文献

[1] Meyers RL, Maibach R, Hiyama E, et al.Risk-stratified staging in paediatric hepatoblastoma: a unified analysis from the Children's Hepatic Tumors International Collaboration. Lancet Oncol, 2017, 18:122-131.
[2] Pugmire BS, Towbin AJ.Magnetic resonance imaging of primary pediatric liver tumors. Pediatr Radiol, 2016, 46:764-777.
[3] Lopez-Terrada D, Zimmermann A.Current issues and controversies in the classification of pediatric hepatocellular tumors. Pediatr Blood Cancer, 2012, 59(5):780-784.
[4] Contrast-enhanced CT features of hepatoblastoma: Can we predict histopathology Cancer Imaging, 2016,16(Suppl 1): 28.
[5] Mackinlay GA, Pritchard H.A common language for child- hood liver-tumors. Pediatr Surg Int, 1992,7:325-326.
[6] Towbin AJ, Meyers RL, Woodley H, et al.2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediat Radiol, 2018,56:1-19.
[7] Spector LG, Birch J.The epidemiology of hepatoblastoma. Pediatr Blood Cancer, 2012, 59:776-779.
[8] McCarville MB, Roebuck DJ. Diagnosis and staging of hepatoblastoma: imaging aspects. Pediatr Blood Cancer,2012, 59:793-799.
[9] Ayllon TD, Gómez BO, Ciria BR, et al.Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review. World J Gastroenterol, 2014, 20(29):10137-10143.
[10] Becker K, Furch C, Schmid I, et al.Impact of postoperative complications on overall survival of patients with hepatoblastoma. Pediatr Blood Cancer,2015, 62(1): 24-28.
[11] Ortega JA, Douglass EC, Feusner JH, et al.Randomized comparison of cisplatin/vincristine/fluorouracil and cisplatin/continuous infusion doxorubicin for treatment of pediatric hepatoblastoma: A report from the Children's Cancer Group and the Pediatric Oncology Group . J Clin Oncol, 2000, 18(14): 2665-2675.
[12] Perilongo G, Shafford E, Maibach R, et al.Risk-adapted treatment for childhood hepatoblastoma. Final report of the second study of the International Society of Paediatric Oncology-SIOPEL 2. Eur J Cancer, 2004, 40:411-421.
[13] Hishiki T, Matsunaga T, Sasaki F, et al.Outcome of hepatoblastomas treated using the Japanese Study Group for Pediatric Liver Tumor (JPLT) protocol-2: report from the JPLT. Pediatr Surg Int, 2011, 27:1-8.
[14] 赵强, 王峥, 乔晓红,等. PRETEXT术前分期在40例肝母细胞瘤手术切除中的价值分析. 中国肿瘤临床, 2011, 38(11):672-674.
[15] Von Schweinitz D.Hepatoblastoma: recent developments in research and treatment. Semin Pediatr Surg, 2012, 21(1):21-30.

PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析^*

Application of PRETEXT staging system in evaluating treatment response of children with hepatoblastoma

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