Survival rates for HB patients have improved; however, outcomes for patients who relapse remain poor. A retrospective review of information gathered for the HB99 study and the German Liver Tumor Registry identified 25 relapse patients (6.9%, 25/362). The median time from initial diagnosis to first relapse was 13 months (range: 5–66 months). Two patients relapsed >36 months after initial diagnosis. A total of 68% (17/25) of relapses were metastatic, 24% local, and 8% combined. 67% of local relapses were alive at the last follow-up, in contrast to 53% of metastatic and 0% of combined relapses. At the last follow-up, 73% (8/11) of patients with lung relapses were still alive (0/4 with peritoneal, 1/2 with CNS involvement). A total of 20% of the patients had AFP-negative relapses, 64% of the relapse patients achieved a second complete remission, 69% were still in complete second remission at the last follow-up (median FU of 66 months), and 83% (5/6) of irinotecan-naïve patients who received relapse treatment including irinotecan were in second complete remission at the last follow-up. The 3-year overall survival/event-free survival from relapse was 63%/48% respectively. There is a good chance that HB patients will achieve a second remission despite a first relapse. However, patients who suffer further relapses tend to have a poorer prognosis.
肝母细胞瘤患者的生存率已有所改善，但复发患者的预后仍然较差。通过对HB99研究及德国肝脏肿瘤登记处收集的数据进行回顾性分析，共发现25例复发患者（占6.9%，25/362）。从初次诊断至首次复发的中位时间为13个月（范围：5-66个月），其中2例患者在初次诊断36个月后复发。复发类型方面，68%（17/25）为转移性复发，24%为局部复发，8%为混合型复发。末次随访时，局部复发患者的存活率为67%，而转移性复发患者为53%，混合型复发患者则为0%。具体到转移部位，肺转移患者中73%（8/11）在末次随访时存活（腹膜转移0/4例存活，中枢神经系统转移1/2例存活）。20%的复发患者表现为甲胎蛋白阴性复发，64%的复发患者实现了二次完全缓解，末次随访时（中位随访时间66个月）仍有69%的患者维持二次完全缓解状态。在既往未使用伊立替康、且接受含伊立替康复发治疗方案的患者中，83%（5/6）在末次随访时处于二次完全缓解状态。复发后3年总生存率与无事件生存率分别为63%和48%。研究显示，肝母细胞瘤患者在首次复发后仍有较大机会获得二次缓解，但经历多次复发的患者往往预后较差。
Hepatoblastoma Relapse—Findings from the German HB99 Trial and the German Liver Tumor Registry
肿瘤(癌症)患者之家