재발성 혹은 불응성 소아 고형암의 치료 성적: 20년 간의 단일기관 경험

Treatment Outcome in Children and Adolescents with Relapsed or Progressed Solid Tumors: A Single Center Experience for 20 years

(구연):

Release Date : 2017. 10. 26(목)

Heewon Cho¹^,1^,1, Youngeun Ma¹^,1^,1, Jiwon Lee¹^,1^,1, Keon Hee Yoo¹^,1^,1, Ki Woong Sung¹^,1^,1 , Hone Hoe Koo¹^,1^,1

Sungkyunkwan University Samsung Medical Center Department of Pediatrics¹

Sungkyunkwan University Samsung Medical Center Department of Pediatrics²

Sungkyunkwan University Samsung Medical Center Department of Pediatrics³

Sungkyunkwan University Samsung Medical Center Department of Pediatrics⁴

Sungkyunkwan University Samsung Medical Center Department of Pediatrics⁵

Sungkyunkwan University Samsung Medical Center Department of Pediatrics⁶

조희원¹^,1^,1, 마영은¹^,1^,1, 이지원¹^,1^,1, 유건희¹^,1^,1, 성기웅¹^,1^,1 , 구홍회¹^,1^,1

성균관대학교 삼성서울병원 소아청소년과¹

성균관대학교 삼성서울병원 소아청소년과²

성균관대학교 삼성서울병원 소아청소년과³

성균관대학교 삼성서울병원 소아청소년과⁴

성균관대학교 삼성서울병원 소아청소년과⁵

성균관대학교 삼성서울병원 소아청소년과⁶

Abstract

Purpose: Relapse/progression occurs in a significant proportion of solid tumors in children and adolescents. However, published studies regarding the outcome of relapsed/progressed solid tumors, altogether as a comprehensive set of data, are scarce. This study aimed to estimate the survival rates after relapse/progression, to explore prognostic factors, and to help identify potential candidates for future studies. Methods: We reviewed the medical records of 258 patients with solid tumors who experienced first relapse/progression and received subsequent salvage treatment at Samsung Medical Center between 1997 and 2016. Results: A total of 60 out of 258 patients remained progression-free during first-line salvage treatment; 26 underwent HDCT/auto-SCT, 9 underwent allo-SCT. Forty-eight patients remained alive at the time of data cut-off. The remaining 198 patients experienced second or subsequent relapse/progression during first-line salvage treatment; 149 received second-line salvage treatment, 50 underwent HDCT/auto-SCT, 35 underwent allo-SCT after second-line salvage treatment. Twenty-three patients remained alive at the time of data cut-off. A total of 202 patients experienced second relapse/progression and 71 patients remained alive with a median follow-up of 5.9 years (range 1.7-19.8 years) from first relapse/progression. The 5-yr PFS and OS were 20.0 ± 2.6% and 27.5 ± 2.7%, respectively. In terms of patterns of relapse, metastatic relapse was associated with worse outcome. The outcome was better when debulking surgery or radiotherapy was applicable at first relapse/progression. The 5-yr OS from HDCT/auto-SCT (n=76) or allo-SCT (n=44) were 34.8 ± 5.8% and 14.4 ± 5.8%, respectively. Tumor status prior to SCT was associated with the outcome after SCT ( P0.001). In the multivariate analysis for OS, relapse/progression during treatment, metastatic relapse/progression and impossible surgical debulking are independent poor prognostic factors (OR 2.21, 1.85, and 1.97 respectively). Conclusion: The outcome in patients who remained progression-free during salvage treatment and underwent subsequent HDCT/auto-SCT or allo-SCT was encouraging. Future studies investigating new options for salvage treatment, such as targeted therapy based on genomic aberration, are needed to improve outcomes in patients with relapsed or progressed solid tumors.

Keywords: Childhood cancer, Relapse/progression , Survival