Comparative study on 184 pediatric and adult patients with rhabdomyosarcoma

　　研究184例儿童与成人横纹肌肉瘤的异同

　　Abstract：Objective To compare the prognostic factors and clinical differences between pediatric and adult rhabdomyosarcoma.Methods We reviewed the clinical data of 184 patients who were diagnosed to have RMS by pathology and had complete follow-up data between January 1993 and June 2009 in the Cancer Institute and Hospital of Tianjin Medical University.There were 93 pediatric patients (age≤18 years) and 91 adult patients (age＞18 years).Results The 1-,3-and 5-year survival rates in the pediatric group were 90.3％,62.0％,43.1％,respectively,while these were 86.8％,35.1％,20.0％,respectively in the adult group.No significant statistical difference was seen in the 1-year survival rates (P =0.454) between the two groups.However the adult group had significantly lower 3-year (P =0.001 ) and 5-year (P =0.007) survival rates.

　　Kaplan-Meier curve also showed that the adult group ( Median survival 26.7 months) had a lower survival rate than the pediatric group (Median survival 47.3 months,Log-rank test P =0.003).Multivariate analysis showed that the histological subtypes,primary site and post-surgical stratification were independent prognostic factors for pediatric RMS,while the histological subtypes,tumor size and post-surgical stratification were responsible for adult RMS prognosis.Significant statistical differences were showed between the pediatric group and adult group in the factors of histological subtypes(Embryonal:77.4 ％ vs 27.5 ％ ; Alveolar or Pleomorphic:22.6％ vs 72.5％ ;P =0.000),primary site(Favorable site:40.9％ vs 22.0％ ; Unfavorable site:59.1％ vs 78.0 ％ ; P =0.006) and distant metastasis(No metastasis:87.1 ％ vs 73.6 ％％ ;Metastasis:12.9％ vs 26.4％ ; P =0.021 ) by Chi-square Test.Conclusions The prognosis of adult RMS is significantly worse than pediatric tumor,and the differences of the histological subtypes,primary site and distant metastases between the two groups should be responsible for it

　　摘要：目的比较儿童和成人横纹肌肉瘤的预后因素和临床差异。方法回顾性分析病理诊断确诊的横纹肌肉瘤和完整的回访资料的184例患者，在1993年1月至2009年6月在唐山医院。93例儿童(≤18岁)和91例成人患者分两组。结果1,3和5岁生存率分别是 90.3％,62.0％,43.1％。而成人分布是86.8％,35.1％,20.0％,一年生存率中两组没有明显的异同。然而成人组明显比3岁(P = 0.001)和5岁(P = 0.007)生存率低。Kaplan-Meier生成曲线显示成人组生存率（平均26.7 个月）比儿童组（平均47.3个月生存率比P = 0.003）低。多种分析结果显示儿童和成人横纹肌肉瘤的组织学类型 ，原发位置和手术部位为独立影响因素。儿童和成人横纹肌肉瘤通过Log-rank检验显示组织学亚型 (胚胎:77.4% vs 27.5%;肺泡或多形性:22.6% vs 72.5%;P = 0.000),原发位置(预后良好的部位:40.9% vs 22.0%;预后不好的部位:59.1% vs 78.0%;P = 0.006)及远端转移(没有转移:87.1% vs 73.6% %;转移:12.9% vs 26.4%;P = 0.021)明显不同。结论 成人比儿童严重，组织学类型,原发部位，及远端转移是主要影响因素。