诱导化疗早期肿瘤体积缩小程度独立预测高危神经母细胞瘤患者预后

The degree of tumor volume reduction during the early phase of induction
chemotherapy is an independent prognostic factor in patients with high-risk
neuroblastoma
Keywords:neuroblastoma;chemotherapy;metaiodobenzylguanidine
score;transplantation;prognosis
Abstract
BACKGROUND:
In patients with
high-risk neuroblastoma, the reduction in primary tumor volume was measured
during the early phase of induction chemotherapy as an indicator of early tumor
response, and the authors investigated whether the degree of tumor volume
reduction could predict outcome in these patients.
METHODS:
Primary tumor
volumes were measured both at diagnosis and at the first tumor response
evaluation (after 2 or 3 cycles of induction chemotherapy) in 90 patients with
high-risk neuroblastoma who had volumetrically evaluable computed tomography or
magnetic resonance scans. If the tumor volume at the first response evaluation
was >40% of the initial tumor volume, then the patient was categorized as a
poor responder; otherwise, the patient was categorized as a good responder.
Outcomes were compared according to the degree of tumor volume reduction at the
first response evaluation.
RESULTS:
The tumor volume reduction was greater
in patients who remained relapse free than in patients who had a relapsed tumor
(median percentage tumor volume, 21% vs 41.5%; P = .037). The 5-year
relapse-free survival rate was higher in the good responders than in the poor
responders (83% [95% confidence interval, 72%-94%] vs 51% [95% confidence
interval, 31%-71%]; P = .002). In a multivariate analysis of relapse-free
survival, a poor early response was identified as an independent, unfavorable
prognostic factor (hazard ratio, 4.24; 95% confidence interval, 1.59-11.29; P =
.004).
CONCLUSIONS:
A greater reduction in tumor volume reduction the
early phase of induction chemotherapy was associated with a better outcome in
patients with high-risk neuroblastoma. Tailoring treatment intensity according
to the early tumor response to induction chemotherapy may improve patient
outcomes. Cancer 2012. ? 2012 American Cancer Society.
原文链接：http://onlinelibrary.wiley.com/doi/10.1002/cncr.27775/abstract