Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2025; 24: 144-155
Мультимодальная терапия лимфатических мальформаций с локализацией в области шеи у детей
https://doi.org/10.24287/1726-1708-2025-24-1-144-155Аннотация
На сегодняшний день сохраняется высокая сложность определения оптимальной тактики лечения пациентов с лимфатической мальформацией (ЛМ) внеорганной шейной локализации (ВШЛ). В рамках данного исследования проведен анализ данных 115 пациентов с ЛМ ВШЛ, перенесших хирургическое удаление и/или склеротерапию в условиях НМИЦ ДГОИ им. Дмитрия Рогачева в период с мая 2012 г. по декабрь 2022 г. включительно. Данное исследование одобрено независимым этическим комитетом и утверждено решением ученого совета ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России. Медиана катамнестического наблюдения пациентов от момента верификации корректного диагноза составила 21,4 мес (Q1; Q3; 4,4; 58,3). В ходе исследования было выявлено, что макрокистозный тип ЛМ повышает вероятность достижения полной ремиссии в 7,4 раза (95% доверительный интервал (ДИ) 2,7–20,5; p < 0,001), наличие хирургического удаления как самостоятельного метода терапии, так и в составе комбинированной терапии – в 6,3 раза (95% ДИ 2,3–16,9; p < 0,001), в то время как наличие ≥ III стадии по классификации de Serres снижает вероятность достижения полной ремиссии в 4,0 раза (95% ДИ 1,5–10,9; p = 0,006), а ≤ 6 баллов по шкале CDS – в 3,2 раза (95% ДИ 1,3–8,4; p = 0,015). При этом стадия ≥ III согласно классификации de Serres повышает риск развития продолженного роста или незначительное (< 50%) сокращение объема ЛМ ВШЛ в 4,2 раза (95% ДИ 1,5–11,7; p = 0,007). В то же время комбинированная терапия и хирургическое удаление как самостоятельная модальность повышают время дожития пациента в 7,4 раза (95% ДИ 2,0–27,8; p = 0,003) и 11,5 раз (95% ДИ 2,2–58,8; p = 0,004) соответственно. Также в ходе исследования была выявлена относительно малая частота развития малых (n = 22; 19,1%) и больших (n = 9; 7,8%) послеоперационных осложнений. На основе проведенного комплексного анализа отмечена значимая роль хирургического удаления как составной части мультимодального персонифицированного лечения, предложен алгоритм определения оптимальной тактики лечения пациентов с ЛМ ВШЛ.
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Pediatric Hematology/Oncology and Immunopathology. 2025; 24: 144-155
Multimodal treatment of neck lymphatic malformations in children
https://doi.org/10.24287/1726-1708-2025-24-1-144-155Abstract
Today, choosing the optimal management of patients with neck lymphatic malformations (NLM) remains a big challenge. In our study, we analyzed data of 115 patients with NLM who had received surgery and/or sclerotherapy at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of Russia from May 2012 to December 2022 inclusive. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of Russia. The median follow-up time from diagnosis verification was 21.4 months (Q1; Q3; 4.4; 58.3). Macrocystic lymphatic malformations were found to increase the probability of complete remission 7.4-fold (95% confidence interval (CI) 2.7–20.5; p < 0.001), while surgery performed either as single-modality therapy or in combination with other treatment increased it 6.3-fold (95% CI 2.3–16.9; p < 0.001). Disease stage ≥ III as classified by de Serres decreased the probability of complete remission fourfold (95% CI 1.5–10.9; p = 0.006), while CDS score ≤ 6 points – 3.2 fold (95% CI 1.3–8.4; p = 0.015). At the same time, disease stage ≥ III according to de Serres increased the risk of continued growth or a small (< 50%) reduction in NML volume 4.2-fold (95% CI 1.5–11.7; p = 0.007). Meanwhile, combined therapy and single-modality surgery increased the patients' survival time 7.4 fold (95% CI 2.0–27.8; p = 0.003) and 11.5 fold (95% CI 2.2–58.8; p = 0.004) respectively. Notably, only a relatively small number of minor (n = 22; 19.1%) and major (n = 9; 7.8%) postoperative complications were registered in our study. The results of our comprehensive analysis highlighted the importance of surgery as part of multimodal personalized treatment and laid the basis for a new algorithm for choosing the optimal management of patients with NLMs.
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