根治性肿瘤切除术治疗肝母细胞瘤儿童血清AFP水平变化及其预测预后的价值分析*

doi:10.3969/j.issn.1672-5069.2025.03.032

摘要/Abstract

摘要： 目的旨在评估接受根治性切除术治疗的肝母细胞瘤(HB)儿童血清甲胎蛋白(AFP)水平变化及其临床意义。方法 2018年1月～2020年12月乐山市市中区妇幼保健院诊治的HB儿童105例,均接受根治性肿瘤切除术治疗。术后随访5年,常规检测血清AFP水平。应用Kaplan-Meier法进行生存分析,比较两组无事件生存期(EFS)和总生存期(OS)。结果本组HB儿童PRETEXT系统分期为I期18例,II期39例,III期41例和IV期7例;术前,I期、II期、III期和IV期患儿血清AFP水平分别为(43261.3±17236.9)μg/L、(47823.4±16921.3)μg/L、(60489.2±18638.3)μg/L和(73482.1±20496.5)μg/L,在术后6个月时分别降至(11.4±0.3)μg/L、(16.5±0.9)μg/L、(28.4±4.6)μg/L和(416.3±12.1)μg/L,III期和IV期患者血清AFP水平仍较高;术后随访,I期患者肿瘤复发、转移、EFS和OS分别为16.7%、5.6%、77.8%和94. 4%,II期分别为20.5%、7.7%、71.8%和92.3%,III期分别为34.1%、12.2%、53.7%和78.0%,而IV期患儿分别为42.9%、57.1%、0.0%和57.1%。结论根治性肿瘤切除术后HB儿童血清AFP水平与肿瘤分期高度相关,分期差的患儿血清AFP水平很难恢复正常,预后也差。

关键词: 肝母细胞瘤, 根治性切除术, 甲胎蛋白, 生存率, 儿童

Abstract: Objective The aim of this study was to investigate serum alpha fetoprotein (AFP) level changes in predicting prognosis of children with hepatoblastoma (HB) after radical resection of tumor. Method 105 pediatric patients with HB were encountered in our hospital between January 2018 and December 2020, all underwent radical tumor resection, and were followed-up for five years. Kaplan-Meier was applied for survival analysis, and event-free survival (EFS) and overall survival (OS) were documented. Result Based on PRETEXT staging, there were stage I in 18 cases, stage II in 39 cases, stage III in 41 cases and stage IV in 7 cases in our series; at presentation, serum AFP levels in stage I, stage II, stage III and stage IV were (43261.3±17236.9)μg/L, (47823.4±16921.3)μg/L, (60489.2±18638.3)μg/L and (73482.1±20496.5)μg/L, which decreased to(11.4±0.3)μg/L, (16.5±0.9)μg/L, (28.4±4.6)μg/L and (416.3±12.1)μg/L, respectively, six months after operation; during follow-up, incidences of tumor relapse, metastasis, EFS and OS in stage I were 16.7%, 5.6%, 77.8% and 94. 4%, in stage II were 20.5%, 7.7%, 71.8% and 92.3%, in stage III were 34.1%, 12.2%, 53.7% and 78.0%, and in stage IV were 42.9%, 57.1%, 0.0% and 57.1%. Conclusion Serum AFP levels in pediatric patients with HB is correlated to tumor stages, and those with stage III and stage IV might have even high serum AFP levels, which decreases hard to normal, and indicating poor prognosis.

Key words: Hepatoblastoma, Hepatectomy, Alpha fetoprotein, Survival, Children

宋锐, 杨建功, 罗丽琴, 吕涛. 根治性肿瘤切除术治疗肝母细胞瘤儿童血清AFP水平变化及其预测预后的价值分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 446-449.

Song Rui, Yang Jiangong, Luo Liqin, et al. Serum alpha-fetoprotein levels in predicting prognosis of children with hepatoblastoma after hepatectomy[J]. Journal of Practical Hepatology, 2025, 28(3): 446-449.

参考文献

[1] Lin YB, Huang SH, Liu S. 2 years is a reasonable age cut-off level for prognostic assessment of children with hepatoblastoma. Eur Rev Med Pharmacol Sci,2023,27(21):10553-10562.
[2] Zhang YT, Feng LH, Zhong XD,et al. Vincristine and irinotecan in children with relapsed hepatoblastoma: a single-institution experience. Pediatr Hematol Oncol. 2015,32(1):18-25.
[3] Qin Z ,Yu H ,Wei J , et al.Circ-CCT2 activates Wnt/β-catenin signaling to facilitate hepatoblastoma development by stabilizing PTBP1 mRNA.CMGH,2023,17(2):175-197.
[4] Viviana B ,Camila M E ,Chen IJ , et al.Bone metastases in hepatoblastoma, an unusual presentation. Case report and review of the literature. Radiol Case Rep,2022,17(11):4272-4275.
[5] Qi YW, Lin WD, Gong L, et al. Efficacy analysis of C5V chemotherapycombined with transcatheter subcutaneous radiofrequency ablation in the treatment of children with advanced (Stage III/IV) hepatoblastoma. Pak J Med Sci,2022,38(7):1802-1807.
[6] 儿童肝母细胞瘤诊疗规范(2019年版)编写审定专家组. 儿童肝母细胞瘤诊疗规范(2019年版). 临床肝胆病杂志,2019,35(11):2431-2434.
[7] Osamu M ,Eiji O ,Masanori N , et al.Usefulness of central radiologic review in clinical trials of children with hepatoblastoma.Pediatr Radiol,2022,53(3):367-377.
[8] Romilly H, Kang AS. Analyzing efficacy of indocyanine green in pediatric thoracoscopic procedures based on a non-systematic review. J Pediatr Endosc Surg,2023,5(4):173-174.
[9] Jane ADN, Sarah E, Saman T, et al. S3667 A rare case of adult hepatoblastoma with concomitant hepatitis B coinfection. Br J Cancer,2023,118(10S):S2376-S2377.
[10] Qian W ,Ning L ,Chaoxu L , et al.BEX1 supports the stemness of hepatoblastoma by facilitating warburg effect in a PPARγ/PDK1 dependent manner.Br J Cancer,2023,129(9):1477-1489.
[11] Kang TC, Sobia M,Issa NN , et al. Unusual progressive hepatic echogenicity of the pediatric liver following intravenous sonographic contrast administration. J Diagn Med Sonogr,2023,39(5):508-516.
[12] Ueno S,Hhakawa H,Yokoyama S,et al.Treatment of infantile hepatoblastoma and related complications.Tokai J Exp C1in Med, 2005.30:203-209.
[13] Qi YW, Liu WD, Gao L,et al. Efficacy analysis of C5V chemotherapy combined with transcatheter subcutaneous radiofrequency ablation in the treatment of children with advanced (Stage III/IV) hepatoblastoma. Pak J Med Sci,2022,38(7):1802-1807.
[14] Hu HM, Zhang WL, Wang YZ,et al. Treatment outcomes for hepatoblastoma children with pulmonary metastasis and extrapulmonary involvement: experience of 36 cases at a single institution. Transl Cancer Res, 2020,9(10):6402-6411.
[15] 刘新献,非凡,郭严延,等. 肝动脉化疗栓塞联合静脉化疗治疗儿童巨大肝母细胞瘤瘤体及甲胎蛋白变化. 实用放射学杂志,2022,38(5):822-825.
[16] 支天,张伟令,张谊,等. 6岁以下儿童肝母细胞瘤临床特征及其预后分析. 中华肝脏病杂志,2021,29(11):1063-1068.
[17] 于啸,张欣贤,辛涛,等. CT及磁共振成像在儿童肝母细胞瘤诊治中的应用进展. 实用放射学杂志,2020,36(6):988-991.
[18] Kanika S ,Sandeep A ,Devasenathipathy K , et al.Role of diffusion weighted MRI (DW-MR) in detection of satellite lesions not detected with multiphase CT scans in hepatoblastoma and its implications for management.Ind J Pediatr,2022,89(10):1-7.
[19] Hwa P K ,Jisun H ,Mang H Y , et al.Outcome of staging chest CT and identification of factors associated with lung metastasis in children with hepatoblastoma.Eur Radiol,2021,31(12):1-8.
[20] Zhi T,Zhang W,Zhang Y,et al. Clinical characteristics and prognosis analysis of“infantile hepatoblastoma-A 15-year respective single-center study.Cancer Manag Res,202l,13:3201-3208.
[21] 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(1):122-131.

根治性肿瘤切除术治疗肝母细胞瘤儿童血清AFP水平变化及其预测预后的价值分析^*

Serum alpha-fetoprotein levels in predicting prognosis of children with hepatoblastoma after hepatectomy

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