Survival
No patients died of relapse and therapy-associated complications at last
follow-up. Twelve patients
developed relapses. Total frequencies of recurrence were once in 5
patients, 2 in 3 patients, 3 in 2 patients, 4 in 1 patient and 6 in 1
patient respectively (Table 1). Among these, 11 patients developed local
relapse (42.3%) and one patient displayed a distant relapse at right
cerebral parietal lobe.
The five-year overall survival (OS) and RFS rates of the whole cohort
were 100.0% and 55.2% with a
median follow-up of 59.5 months (range, 16-155 months, Figure 1). The
estimated 5-year RFS rates for stage Ⅲ and stage Ⅳ were 50.9% and
62.5%, respectively (P = 0.40). There was a trend towards better 5-year
RFS for girls
(64.2%
± 17.6%) compared with boys
(40.0% ± 15.5%) (P = 0.02). The
RFS between the two age groups(≤2 years vs >2 years) was
not significantly different(P = 0.82)(Table 3). Regarding AFP level, the
5-year RFS rate was 56.3% for ≤60,000ng/ml, and this rate was higher
than for >60,000 ng/ml (P = 0.91; Table 3). The 5-year RFS
of patients with poor pathological response was impaired as compared
with good pathological response (38.7% ± 13.0%; 11 of 20 patients
versus 100%; 9 of 20 patients; P = 0.03). No risk factors were
considered prognostically unfavorable in multivariate analysis.
Although no variables except gender were significantly associated with
RFS (Table 2), good pathological responders, smaller initial tumor size
and lower AFP level represented favorable prognostic factors in terms of
RFS. Based on clinical significance of these three factors in
combination with gender, the sum of the points(adverse factors: male or
poor pathological responder or
initial tumor size greater than 4.0 cm×3.0 cm or AFP
>60000ng/ml) allotted correlated with the following risk
groups: groupⅠ(n = 11,
55.0%), 0-2 adverse factors; group
Ⅱ (n = 9, 45.0%), 3-4
adverse factors. Table 4 showed two patients developed relapse in
groupⅠand five patients had relapse in groupⅡ. Seven patients were in
alive after salvage therapy. Boys accounted predominantly in group Ⅱ
that might be responsible for the significant difference. We excluded
sex in further analysis and stratified the cohort into two groups
according to initial tumor size, pathological responders and AFP level.
No relapse was observed in groupⅠwith 0-1 adverse risk factor. Seven
patients developed relapse in group Ⅱ with 2-3 adverse risk factors (P =
0.07, Table 5).