颅内生殖细胞瘤患儿血清甲胎蛋白水平与预后的关系
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摘要
目的通过比较血清甲胎蛋白(AFP)升高与AFP正常的颅内生殖细胞瘤患儿预后,探讨血清AFP水平与颅内生殖细胞瘤的预后关系。方法选取70例经病理学明确诊断为颅内生殖细胞瘤的患儿,其中56例血清AFP正常(AFP﹤25 ng/ml)患儿为AFP正常组,14例血清AFP升高(AFP≥25 ng/ml)患儿为AFP升高组,比较两组患儿的病理类型、疗效和生存情况。结果 AFP正常组中生殖细胞瘤比例为80.36%(45/56),明显高于AFP升高组中的0%(0/14),差异有统计学意义(χ2=31.500,P﹤0.01)。AFP正常组与AFP升高组患儿疗效比较,差异无统计学意义(Z=0.420,P﹥0.05)。AFP正常组患儿生存情况明显优于AFP升高组患儿,差异有统计学意义(χ2=11.685,P﹤0.01)。结论血清AFP升高的颅内生殖细胞瘤患儿相较于血清AFP正常患儿,预后较差,采用化疗联合低剂量放疗近期疗效确切,治疗后应密切随访。
Objective To investigate the relationship between serum alpha-fetoprotein(AFP) level and prognosis of children with intracranial germ cell tumor by comparing the serum increased AFP level with normal AFP level. Method The clinical data of 70 children with pathologically confirmed intracranial germ cell tumor were analyzed. Among them,56 children with normal serum AFP(AFP<25 ng/ml) were assigned as normal AFP group, another 14 children with elevated serum AFP(AFP≥25 ng/ml) were allocated as increased AFP group. The pathological type, efficacy and survival in both groups were compared. Result In normal AFP group, the proportion of patients with germ cell tumor was 80.36%(45/56), and it was significantly higher compared to the increased AFP group at 0(0/14), indicating statistical significance(χ2=31.500, P<0.01). There was no significant difference regarding the efficacy between the two groups of children(Z=0.420, P>0.05). The survival of the normal AFP group was significantly better than that of the increased AFP group,showing statistically significant difference(χ2=11.685, P<0.01). Conclusion The children with intracranial germ cell tumor with elevated serum AFP have a poorer prognosis than those with normal serum AFP. Chemotherapy combined with low-dose radiotherapy is effective in the treatment of these patients, who should be followed closely.
Objective To investigate the relationship between serum alpha-fetoprotein(AFP) level and prognosis of children with intracranial germ cell tumor by comparing the serum increased AFP level with normal AFP level. Method The clinical data of 70 children with pathologically confirmed intracranial germ cell tumor were analyzed. Among them,56 children with normal serum AFP(AFP<25 ng/ml) were assigned as normal AFP group, another 14 children with elevated serum AFP(AFP≥25 ng/ml) were allocated as increased AFP group. The pathological type, efficacy and survival in both groups were compared. Result In normal AFP group, the proportion of patients with germ cell tumor was 80.36%(45/56), and it was significantly higher compared to the increased AFP group at 0(0/14), indicating statistical significance(χ2=31.500, P<0.01). There was no significant difference regarding the efficacy between the two groups of children(Z=0.420, P>0.05). The survival of the normal AFP group was significantly better than that of the increased AFP group,showing statistically significant difference(χ2=11.685, P<0.01). Conclusion The children with intracranial germ cell tumor with elevated serum AFP have a poorer prognosis than those with normal serum AFP. Chemotherapy combined with low-dose radiotherapy is effective in the treatment of these patients, who should be followed closely.
引文
[1] Hu M, Guan H, Lau CC, et al. An update on the clinical diagnostic value ofβ-h CG andαFP for intracranial germ cell tumors[J]. Eur J Med Res, 2016, 21:10.
[2]连欣,张福泉.原发性颅内生殖细胞肿瘤的诊断和治疗[J].协和医学杂志, 2014, 5(2):197-201.
[3] Chen YW, Huang PI, Ho DM, et al. Change in treatment strategy for intracranial germinoma:long-term follow-up experience at a single institute[J]. Cancer, 2012, 118(10):2752-2762.
[4] Correia D, Terribilini D, Zepter S, et al. Whole-ventricular irradiation for intracranial germ cell tumors:dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy[J]. Clin Transl Radiat Oncol, 2019, 15:53-61.
[5] Zschaeck S, Wust P, Graf R, et al. Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma[J]. Radiat Oncol, 2018, 13(1):251.
[6] Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment[J]. Cancer, 1981, 47(1):207-214.
[7] Aihara Y, Watanabe S, Amano K, et al. Placental alkaline phosphatase levels in cerebrospinal fluid can have a decisive role in the differential diagnosis of intracranial germ cell tumors[J]. J Neurosurg, 2018, 1:1-8.
[8] Pak VN. The use of alpha-fetoprotein for the treatment of autoimmune diseases and cancer[J]. Ther Deliv, 2018, 9(1):37-46.
[9] Rogers SJ, Mosleh-Shirazi MA, Saran FH. Radiotherapy of localised intracranial germmoma:time to sever historical ties?[J]. Lancet Oncol, 2005, 6(7):509-519.
[10] Robertson PL, Da Rosso RC, Allen JC. Improved prognosis of intracranial non-germinoma germ cell tumors with multimodality therapy[J]. J Neurooncol, 1997, 32(1):71-80.
[11] Weiner HL, Lichtenbaum RA, Wisoff JH, et al. Delayed surgical resection of central nervous system germ cell tumors[J]. Neurosurgery, 2002, 50(4):727-734.
[12] Kim A, Ji L, Balmaceda C, et al. The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors[J]. Pediatr Blood Cancer, 2008, 51(6):768-773.
[13]肖罡,方陆雄,邱炳辉,等.原发性松果体区混合性生殖细胞肿瘤病理特点及其起源探讨[J].南方医科大学学报, 2011, 31(3):429-433.
[14] Chen R, Tao C, You C, et al. Fast-developing fatal diffuse leptomeningeal dissemination of a pineal germinoma in a young child:a case report and literature review[J]. Br J Neurosurg, 2018, 19:1-8.
[15] Jiang T, Raynald, Yang H, et al. Predictive factors of overall survival in primary intracranial pure choriocarcinoma[J]. J Clin Neurosci, 2019, 61:93-101.
[16] Sawamura Y, Ikeda J, Shirato H, et al. Germ cell tumours of the central nervous system:treatment consideration based on 111 cases and their long-term clinical outcomes[J]. Eur J Cancer, 1998, 34(1):104-110.
[17] Hwang K, Lee KS, Choe G, et al. Secondary glioblastoma after treatment of intracranial germinoma-would radiationonly therapy still be safe? case report[J]. BMC Cancer,2018, 18(1):1119.
[18] PYM W, Kakaizada S, CCY C, et al. Diagnostic radiationinduced regression of a metastatic primary intracranial germinoma:a case report[J]. Br J Neurosurg, 2018:1-4.
[19]赵雪臻.经病理明确诊断的儿童原发颅内生殖细胞肿瘤52例的临床回顾及随诊[D].北京:北京协和医学院,2016.
[20] Lee D, Suh YL. Histologically confirmed intracranial germ cell tumors; an analysis of 62 patients in a single institute[J]. Virchows Arch, 2010, 457(3):347-357.
[2]连欣,张福泉.原发性颅内生殖细胞肿瘤的诊断和治疗[J].协和医学杂志, 2014, 5(2):197-201.
[3] Chen YW, Huang PI, Ho DM, et al. Change in treatment strategy for intracranial germinoma:long-term follow-up experience at a single institute[J]. Cancer, 2012, 118(10):2752-2762.
[4] Correia D, Terribilini D, Zepter S, et al. Whole-ventricular irradiation for intracranial germ cell tumors:dosimetric comparison of pencil beam scanned protons, intensity-modulated radiotherapy and volumetric-modulated arc therapy[J]. Clin Transl Radiat Oncol, 2019, 15:53-61.
[5] Zschaeck S, Wust P, Graf R, et al. Locally dose-escalated radiotherapy may improve intracranial local control and overall survival among patients with glioblastoma[J]. Radiat Oncol, 2018, 13(1):251.
[6] Miller AB, Hoogstraten B, Staquet M, et al. Reporting results of cancer treatment[J]. Cancer, 1981, 47(1):207-214.
[7] Aihara Y, Watanabe S, Amano K, et al. Placental alkaline phosphatase levels in cerebrospinal fluid can have a decisive role in the differential diagnosis of intracranial germ cell tumors[J]. J Neurosurg, 2018, 1:1-8.
[8] Pak VN. The use of alpha-fetoprotein for the treatment of autoimmune diseases and cancer[J]. Ther Deliv, 2018, 9(1):37-46.
[9] Rogers SJ, Mosleh-Shirazi MA, Saran FH. Radiotherapy of localised intracranial germmoma:time to sever historical ties?[J]. Lancet Oncol, 2005, 6(7):509-519.
[10] Robertson PL, Da Rosso RC, Allen JC. Improved prognosis of intracranial non-germinoma germ cell tumors with multimodality therapy[J]. J Neurooncol, 1997, 32(1):71-80.
[11] Weiner HL, Lichtenbaum RA, Wisoff JH, et al. Delayed surgical resection of central nervous system germ cell tumors[J]. Neurosurgery, 2002, 50(4):727-734.
[12] Kim A, Ji L, Balmaceda C, et al. The prognostic value of tumor markers in newly diagnosed patients with primary central nervous system germ cell tumors[J]. Pediatr Blood Cancer, 2008, 51(6):768-773.
[13]肖罡,方陆雄,邱炳辉,等.原发性松果体区混合性生殖细胞肿瘤病理特点及其起源探讨[J].南方医科大学学报, 2011, 31(3):429-433.
[14] Chen R, Tao C, You C, et al. Fast-developing fatal diffuse leptomeningeal dissemination of a pineal germinoma in a young child:a case report and literature review[J]. Br J Neurosurg, 2018, 19:1-8.
[15] Jiang T, Raynald, Yang H, et al. Predictive factors of overall survival in primary intracranial pure choriocarcinoma[J]. J Clin Neurosci, 2019, 61:93-101.
[16] Sawamura Y, Ikeda J, Shirato H, et al. Germ cell tumours of the central nervous system:treatment consideration based on 111 cases and their long-term clinical outcomes[J]. Eur J Cancer, 1998, 34(1):104-110.
[17] Hwang K, Lee KS, Choe G, et al. Secondary glioblastoma after treatment of intracranial germinoma-would radiationonly therapy still be safe? case report[J]. BMC Cancer,2018, 18(1):1119.
[18] PYM W, Kakaizada S, CCY C, et al. Diagnostic radiationinduced regression of a metastatic primary intracranial germinoma:a case report[J]. Br J Neurosurg, 2018:1-4.
[19]赵雪臻.经病理明确诊断的儿童原发颅内生殖细胞肿瘤52例的临床回顾及随诊[D].北京:北京协和医学院,2016.
[20] Lee D, Suh YL. Histologically confirmed intracranial germ cell tumors; an analysis of 62 patients in a single institute[J]. Virchows Arch, 2010, 457(3):347-357.