侵犯脉络膜视网膜母细胞瘤患儿的治疗及预后分析  

Treatment and prognostic analysis of retinoblastoma patients with choroid invasion

作　　者：王一卓[1] 黄东生[1] 史季桐[2] 马建民 李彬[2] 项晓琳[2] 胡慧敏[1] 周燕[1] 顾华丽[1] 

机构地区：[1]首都医科大学附属北京同仁医院儿科,100730 [2]首都医科大学附属北京同仁医院眼科,100730

出　　处：《中华儿科杂志》2016年第11期819-822,共4页Chinese Journal of Pediatrics

摘　　要：目的 观察眼球摘除术后病理侵犯脉络膜的视网膜母细胞瘤（RB）患儿的治疗及预后情况.方法 选取北京同仁医院2006年1月至2013年12月临床确诊为单眼RB,眼球摘除后病理诊断侵犯脉络膜的149例患儿为研究对象,根据其病理侵犯程度分为大范围脉络膜侵犯和局限性侵犯,大范围脉络膜侵犯是指侵犯直径≥3 mm和（或）侵犯脉络膜全层厚度,局限性脉络膜侵犯指部分厚度且直径＜3 mm.二者分别给予相应的治疗,观察不同范围脉络膜侵犯的预后情况,并根据是否合并病理学高危因素进行分组,比较其生存情况.随访时间1～9年,中位随访时间4年1个月.结果 149例患儿中男90例,女59例;右眼81例,左眼68例.149例行眼球摘除后的RB患儿死亡16例,总生存率为89.3％,侵犯大范围脉络膜的患儿有47例,9例复发死亡,生存率为80.9％,侵犯局限性脉络膜的患儿有102例,7例复发死亡,生存率为93.1％,二者差异有统计学意义（x2=5.067,P =0.024）;侵犯大范围脉络膜不合并病理学高危因素的患儿有8例,复发死亡0例;合并病理学高危因素的患儿有39例,9例复发死亡,病死率为23.1％,二者差异无统计学意义（P =0.323）.侵犯局限性脉络膜不合并病理学高危因素的患儿有60例,复发死亡0例;合并病理学高危因素的患儿有42例,7例复发死亡,二者差异有统计学意义（P =0.003）.病理学高危因素的COX回归分析显示：肿瘤侵犯大范围脉络膜和侵犯视神经断端是影响预后的危险因素.结论 单纯侵犯局限性脉络膜的患儿复发率低,可以不做辅助化疗;单纯侵犯大范围脉络膜的患儿术后是否做辅助化疗,应当进一步做前瞻性研究;侵犯大范围脉络膜合并病理学高危因素的患儿复发率高,应当予以辅助化疗.Objective To observe the treatment and prognosis of choroid invasion of retinoblastoma （RB） in children.Method A total of 149 children who had been diagnosed with unilateral RB and received enucleation disclosing tumor invasion to choroid from January 2006 to December 2013 in Beijing Tongren Hospital were recruited in this study.Choroid involvement was classified as massive choroid invasion and focal choroid invasion.Massive choroid invasion was defined as a maximum diameter of invasive tumor focus of 3 mm or more in diameter that might reach the scleral tissue.Focal choroid invasion was defined as a tumor focus of less than 3 mm in diameter without involvement of sclera.The treatment was delivered according to the invasive status of tumor with combination of histopathological high risk factors.The prognosis of different degrees of choroid invasion was observed.They were divided into two groups according to whether the merger of other high histopathologic risk factors,the survival situation was compared.The subjects were followed up for 1 to 9 years （the median follow-up time：4 years and 1 month）.Result Among the 149 subjects,90 were boys and 59 were girls.The right eye was affected in 81 patients and the left eye in 68 patients.Sixteen patients died,resulting in an overall survival rate of 89.3%.Among massive choroid invasion in 47 cases,9 patients experienced disease recurrence and death resulting in a survival rate of 80.9%.While the focal choroid invasion was found in 102 cases,only 7 children had disease relapsed and died resulting in a survival rate of 93.1% which was statistically significant （x2 =5.067,P =0.024）.Among 8 patients with massive choroid invasion without pathological high-risk factors,no death occurred,while in other 39 patients with high-risk factors,9 died with a mortality rate of 23.1%,however,the difference was not statistically significant （Fisher＆#39;s exact probability method,P =0.323）.Among 60 patients with focal choroid invasion without pathological high-risk facto

关 键 词：视网膜母细胞瘤 脉络膜 预后 儿童 

分 类 号：R739.7[医药卫生—肿瘤]