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Purpose@#This study was performed to establish and validate a nomogram for predicting the overall survival in children with neuroblastoma. @*Methods@#The latest clinical data of neuroblastoma in Surveillance, Epidemiology, and End Results (SEER) database was extracted from 2000 to 2016. The cases included were randomly divided into training and validation cohorts. The survival curves were drawn with a Kaplan-Meier estimator to investigate the influences of certain single factors on overall survival. Also, least absolute shrinkage and selection operator regression was applied to further select the prognostic variables for neuroblastoma. Additionally, receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the accuracy of the nomogram. @*Results@#In total, 1,262 patients were collected and 8 independent prognostic factors were achieved, including patients’ age, sex, race, tumor grade, radiotherapy, chemotherapy, tumor site, and tumor size. Then we constructed a nomogram by using the data of the training cohort with 886 cases. Subsequently, the nomogram was validated internally and externally with 886 and 376 cases, respectively. The internal validation revealed that the area under the curves (AUC) of ROC curves of 1-, 3-, and 5-year overall survival were 0.69, 0.78, and 0.81, respectively. Accordingly, the external validation also showed that the AUC of 1-, 3-, and 5-year overall survival were all ≥0.69. Both methods of validation demonstrated that the predictive calibration curves were consistent with standard curves. @*Conclusion@#The nomogram possess the potential to be a new tool in predicting the survival rate of neuroblastoma patients.
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Purpose@#This study was performed to establish and validate a nomogram for predicting the overall survival in children with neuroblastoma. @*Methods@#The latest clinical data of neuroblastoma in Surveillance, Epidemiology, and End Results (SEER) database was extracted from 2000 to 2016. The cases included were randomly divided into training and validation cohorts. The survival curves were drawn with a Kaplan-Meier estimator to investigate the influences of certain single factors on overall survival. Also, least absolute shrinkage and selection operator regression was applied to further select the prognostic variables for neuroblastoma. Additionally, receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the accuracy of the nomogram. @*Results@#In total, 1,262 patients were collected and 8 independent prognostic factors were achieved, including patients’ age, sex, race, tumor grade, radiotherapy, chemotherapy, tumor site, and tumor size. Then we constructed a nomogram by using the data of the training cohort with 886 cases. Subsequently, the nomogram was validated internally and externally with 886 and 376 cases, respectively. The internal validation revealed that the area under the curves (AUC) of ROC curves of 1-, 3-, and 5-year overall survival were 0.69, 0.78, and 0.81, respectively. Accordingly, the external validation also showed that the AUC of 1-, 3-, and 5-year overall survival were all ≥0.69. Both methods of validation demonstrated that the predictive calibration curves were consistent with standard curves. @*Conclusion@#The nomogram possess the potential to be a new tool in predicting the survival rate of neuroblastoma patients.
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Objective To explore the clinical data of the pediatric malignant solid tumor and to summarize the experiences of the pediatric malignant solid tumor treatment in Guangxi.Methods The clinical data of 323 cases of pediatric malinant solid tumor,treated surgically in the First Affiliated Hospital of Guangxi Medical University from Dec.1988 to Dec.2008.Pathology,sex,age,clinical characteristics,diagnosis and treatment were analysed respectively.Results The most frequent histological types were malignant lymphoma,Wilms tumor,neuroblastoma and malignant germ cell tumor.There was a male prevalence with a sex-ratio of 1.99 ∶ 1.The peak incidence in embryo tumor was under 3 years,and epithelium cancer was between the ages of 10-13 years.The main symptoms were palpable mass (56.3) and a few were found in health examination ;64.2％ of the pediatric malignant solid tumor was of stage Ⅲ or Ⅳ ;the complete tumor resection rate was 78.4％.Conclusions The characteristics of pediatric malignant solid tumor is different from those of adults.To detect as soon as possible and treat the pediatric malignant tumor as soon as possible depends on screening.Combined modality therapy can improve the patients complete resection rate and survival quality of the patients.
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Objective To explore the role of Santulli procedure enterostomy in treatment of high unformed small bowel fistula in children.Methods From May 2007 to Oct.2011,6 cases suffered with high unformed small bowel fistula were treated with Santulli procedure enterostomy.Five male and 1 female were involved and their ages were ranged from 15 days to 5 years.Results The mean time from final diagnosis of intestinal fistula to the definite operation was (52.33 ± 19.03) h,the distance between fistula to the ligament of Treize was (17.33 ± 4.68)cm,the output of enterostomy was (760.00 ± 107.56) mL/d.In the surgical explore,6 cases suffered intestinal adhesions but none of the cases could be separated,5 cases suffered severe and 1 case with moderate intra-abdominal pollution.The preoperative complications included 6 cases with incision infection,1 case with a fully dehiscence of incision,6 cases with generalized peritonitis,2 cases with impaired renal function,1 case with liver dysfunction,3 cases with systemic inflammatory reaction syndrome and sepsis respectively,1 case of incision infection appeared in post-operation.The pediatric critical illness scores and serum albumin of postoperative 3 days and 7 days were higher than those of preoperative (all P ＜0.05).None of the cases suffered the anastomotic leak.The nutrition and growth were normal during the follow-up period of 8 months to 2 years.Conclusions Santulli procedure enterostomy is suitable in treatment of high unformed small bowel fistula in children,and the early performance will improve prognosis.
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Objective To investigate the value and strategy of staged repair in hypospadias surgery.Methods One hundred and sixty-three cases of severe proximal and complex hypospadias were retrospectively analyzed.According to the operation process,all the cases were divided into 2 groups.Staged repair group:there were 46 cases in all,included 31 cases of severe proximal hypospadias and 15 cases cases of complex hypospadias,the diorthosis for penis curvature and urethral reconstruction were completed by staged.One-stage repair group:there were 117 cases as control group,included 108 cases of severe proximal hypospadias and 9 cases of complex hypospadias,their diorthosis for penis curvature and urethral reconstruction were completed in single stage.Results The adverse factors such as a serious deformity in penis or limited local tissue were more common in staged repair group,and the conditions of repair were worse than one-stage repair group.In severe proximal hypospadias,the incidence of penis curvature in staged repair group was obvious lower than one-stage repair group (P ＜ 0.05),within the period of follow up,which only 1 case (3.2％) showed a slight penis curvature.However,there were 23 cases (21.3％) with penis curvature in one-stage repair group,in which 7 cases showed up penis torsion,20 cases with a bowstring shape of breviate urethra in penile ventral,and 19 cases(17.6％) needed reoperation.Compared of 2 groups,the incidences of urinary fistula,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).In complex hypospadias,the incidence of urinary fistula in staged repair group was significantly lower than one-stage repair group,and then the rate of urinary fistula was 20.0％ vs 66.7％ (P ＜ 0.05).The incidence of penis curvature,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).Conclusions Staged repair is relatively simple and effective,can be used in the treatment of severe proximal or complex hypospadias,especially in the cases with a worse condition.The mode of operation should be chosen not only according to the penial state and tissue conditions,but also combined with the technology and experience of the surgeon,and avoid the forced of one-staged repair for hypospadias.
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<p><b>OBJECTIVE</b>To review the indications, techniques and complications of reoperation for failed hypospadias repair using modified Mathieu urethroplasty.</p><p><b>METHODS</b>Using modified Mathieu urethroplasty, we treated 24 hypospadias patients aged 3-12 (mean 4.5) years for whom the first (n = 20) or the second hypospadias repair (n = 4) had failed, including 13 cases of large coronary sulcus urethrocutaneous fistula, 5 cases of urethral meatus retraction and 6 cases of anterior urethra dehiscence. The modified procedure involved median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.</p><p><b>RESULTS</b>Of the 24 patients, 19 (79.2%) were successfully treated by the first operation, which achieved desirable straightness, good cosmetic appearance and normal urethral meatus of the penis, without postoperative complications. Small urethrocutaneous fistula developed in 4 cases, of which 3 were cured by fistula repair and 1 self-healed. Urethral meatus stenosis occurred in 1 case, which was restored by meatal dilation. Urethrocele and urethrostenosis were not found in any of the cases. Two cases received urethroscopy postoperatively, which revealed no hypertrophic cicatrix at the site of median longitudinal incision in the urethral posterior wall.</p><p><b>CONCLUSION</b>Modified Mathieu urethroplasty can be applied to hypospadias reoperation, particularly in such cases as large coronary sulcus urethrocutaneous fistula, urethral meatus retraction and anterior urethra dehiscence. The modified procedure includes median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.</p>
Subject(s)
Child , Child, Preschool , Humans , Male , Hypospadias , General Surgery , Plastic Surgery Procedures , Methods , Reoperation , Treatment Outcome , Urethra , General Surgery , Urologic Surgical Procedures, Male , MethodsABSTRACT
<p><b>OBJECTIVE</b>To assess the outcome of childhood hepatoblastoma after a combination therapy of resection and chemotherapy.</p><p><b>METHODS</b>The clinical data of 14 children with hepatoblastoma was retrospectively reviewed. Their long-term survival was followed-up.</p><p><b>RESULTS</b>Twelve cases received surgery and planned chemotherapy. The follow-up duration averaged 18 months (range 1.5-74 months). Nine survived free of events, 1 died, 1 survived with multiple lung metastases, and 1 with increased alpha-fetoprotein (AFP) content but without residual tumor.</p><p><b>CONCLUSIONS</b>Surgery assisted with chemotherapy can improve the outcome of hepatoblastoma.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Chemoembolization, Therapeutic , Combined Modality Therapy , Hepatoblastoma , Blood , Therapeutics , Lung Neoplasms , Blood , Therapeutics , Retrospective Studies , Treatment Outcome , alpha-FetoproteinsABSTRACT
Objective To investigate the effect of surgical intervention combined with steroid therapy on infantile hepatitis(INS) with persistent jaundice.Methods Twenty-two patients (19 males,3 females,aged 2-6 months) with persistent jaundice(therapy group) were admitted into hospital in the period of Jan.2007-Dec.2008.The patients were performed with surgical intervention after they were confirmed with diagnosis as INS.Then,sodium chloride,gentamicin and Dexamethasone were used to irrigate the biliary tract during and after the operation for 14 days.Three days after operation,20 mg,15 mg,10 mg,5 mg of methylprednisolone were administered intravenously to the patients every 3 days,followed with 4 mg/(kg?d) prednisone by oral for 2-3 months.The 17 cases of INS with persistent jaundice were treated with medicine as control(control group).By following-up,the jaundice free and 2 years survival rate of 2 groups were compared by counting the cases of jaundice free and recording the survival time.Results Two cases of 22 patients performed with surgical intervention were diagnosed as biliary atresia and others were INS,90.0% patients were free of jaundice in surgical intervention combined with steroid therapy group,which was higher than that in control group(52.9%,P