Objective: To summarize and analyze the treatment process, long-term efficacy and clinical economics of children's hepatoblastoma (HB) in multi-disciplinary team (MDT) mode, so as to provide basis for the rational choice of diagnosis and treatment.
Methods: From January 2014 to February 2019, 13 cases of hepatoblastoma in children who completed the whole treatment course in the Pediatric Hematology Tumor Ward of Peking University First Hospital were collected and analyzed, and were followed up until June 30, 2020. There were 9 males and 4 females who were diagnosed and treated according to the MDT process in the hospital. The median age was 16 months (2-54 months), 69.23% (9/13) were under 2 years old. The characteristics, diagnosis and treatment process and treatment effect of the cases were summarized, and the cost of clinical treatment was analyzed.
Results: According to the pretreatment extent of disease(PRETEXT), there were 1, 9 and 3 children with stages Ⅱ, Ⅲ and Ⅳ. 76.92% (10/13) of the patients had the largest tumor diameter > 10 cm. All the patients received preoperative neoadjuvant chemotherapy (8 patients received 4 cycles of chemotherapy, and 6 patients changed the chemotherapy plan), surgical treatment and postoperative chemotherapy, the tumor volume decreased by more than 50% (64%-95%) in 12 cases, except 1 case with no significant increase of alpha fetal protein and multiple lesions.The median length of stay was 87 days (68-214 days), the median cost of stay was 200 000 yuan (115 000-500 000 yuan), the median length of stay was 7 days (5-17 days), the median cost of stay was 20 000 yuan (15 000-60 000 yuan), and the incidence of postoperative complications was 7.69% (1/13). All the patients were followed up for 16-69 months. All the patients survived.
Conclusion: Under the MDT mode, the treatment is seamless connection, the long-term prognosis of children with HB is good, and the total hospitalization cost and time are within the acceptable range. Standard preoperative neoadjuvant chemotherapy can significantly reduce the tumor, improve the resection rate, reduce postoperative complications, reduce the total individual expenditure, shorten the total hospital stay, and further improve the long-term disease-free survival rate.
目的: 总结并分析儿童肝母细胞瘤(hepatoblastoma, HB)在多学科协作模式(multi-disciplinary team, MDT)下的治疗过程、长期疗效及临床经济支出情况, 为合理选择诊治方式提供依据。
方法: 收集2014年1月至2019年2月在北京大学第一医院儿科血液肿瘤病房完成全部诊治疗程的13例儿童肝母细胞瘤的资料, 并进行分析, 随访至2020年6月30日, 男9例, 女4例, 就诊时中位年龄16个月(2~54个月), 2岁以下者占69.23%(9/13)。按照北京大学第一医院MDT流程进行诊疗, 总结病例特点、诊疗过程和治疗效果, 同时对临床经济支出进行分析。
结果: 初诊按治疗前病变范围(pretreatment extent of disease, PRETEXT)分期, Ⅱ、Ⅲ、Ⅳ期患儿分别为1、9、3例, 肿瘤最大径>10 cm者占76.92%(10/13)。所有患儿均行术前新辅助化疗(8例行4周期化疗, 6例中途更换化疗方案)、手术治疗及术后化疗, 术前除1例甲胎蛋白无明显升高、多发病灶、肿瘤体积减小16%的患儿外, 其余12例患儿肿瘤体积均减小50%以上(64%~95%)。总住院时间中位数为87 d (68~214 d), 总住院费用的中位数为20.0万元(11.5~50.0万元); 围手术期中位住院时间7 d (5~17 d), 围手术期中位住院费用为2.0万元(1.5~6.0万元), 术后并发症发生率7.69%(1/13)。术后均按时行下一周期化疗, 随访时间16~69个月, 患儿全部无肿瘤复发生存。
结论: 在MDT诊治模式下, 治疗无缝衔接, 儿童HB的长期预后良好, 且总住院费用及时间均在可接受范围内; 规范的术前新辅助化疗可使肿瘤显著减小, 提高手术切除率, 减少术后并发症, 缩减总住院时间, 可能减少个体总支出费用, 并进一步提高长期无病生存率。
Keywords: Clinical economic expenditure; Hepatoblastoma; Multi-disciplinary team model.