视网膜母细胞瘤综合治疗的回顾性临床研究  

Retrospective clinical study on the comprehensive treatment of retinoblastoma

作　　者：程湧[1] 贾忠旭 赵明威[1] 梁建宏[1] Cheng Yong;Jia Zhongxu;Zhao Mingwei;Liang Jianhong(Department of Ophthalmology,Peking University People’s Hospital,Eye Diseases and Optometry Institute,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases,College of Optometry,Peking University Health Science Center,Beijing 100044,China)

机构地区：[1]北京大学人民医院眼科、眼视光中心,眼病与视光医学研究所,视网膜脉络膜诊治研究北京市重点实验室,北京大学医学部眼视光学院,100044

出　　处：《中华眼底病杂志》2020年第6期419-424,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察视网膜母细胞瘤(RB)患儿综合治疗的疗效、生存率、眼球摘除率以及病理特点。方法回顾性临床研究。1999年3月至2018年12月于北京大学人民医院眼科检查确诊且行综合治疗的RB患儿313例445只眼纳入研究。其中,男性175例(55.9%),女性138(44.1%)例;单眼181例,双眼132例。国际眼内RB分期标准(IIRC)分期,A、B、C、D、E期以及眼外期分别为6、13、6、52、227、9例。313例中,明确最终是否生存245例,其中死亡22例(9.0%,22/245)。445只眼中,明确最终是否摘除眼球330只眼;初诊时有明确IIRC分期、眼部检查结果以及眼球摘除前有明确治疗方案及次数、手术后有明确pTNM(pathological tumor node metastasis)分期者184只眼。记录患儿基本信息、人口学特征、临床信息、眼球摘除及治疗方案、病理及免疫组织化学检查结果。采用二元logistic回归方法分别分析RB患儿眼球摘除、病理检查是否存在高危病理特征(HRF)以及预后的危险因素。结果1999年至2018年,明确最终是否生存的245例患儿的生存率由82.6%逐年提高至96.3%;明确是否最终摘除眼球的330只眼的眼球摘除率由68.8%逐年降低至58.3%。D期、E期患眼眼球摘除率分别从2005年前的83.3%和100%下降至2014年之后的37.5%和85.4%。单眼发病(β=-1.551,P=0.005)、IIRC分期中D、E期和眼外期(P<0.005)是RB最终眼球摘除的独立危险因素,而眼动脉介入化学药物治疗(IAC)是其保护因素(β=-0.877,P<0.001)。病理检查出现HRF 51只眼(27.7%)。发病月龄大(β=0.019,P=0.016)、青光眼期(β=0.816,P=0.050)是RB病理存在HRF的独立危险因素,而IAC是眼球摘除的保护因素(β=21.432,P<0.001)。结论综合治疗后,RB眼球摘除率总趋势逐渐下降,IAC治疗可降低D、E期眼球摘除率;较大的发病月龄、青光眼期是HRF的独立危险因素,而IAC能降低HRF存在的危险因素。Objective To observe the curative effect,survival rate,enucleation rate and pathological characteristics of retinoblastoma(RB)in children.Methods Retrospective clinical study.From March 1999 to December 2018,a total of 313 patients(445 eyes)with RB diagnosed in Ophthalmology Department of Peking University People’s Hospital were enrolled in the study.Among them,175 were male(55.9%),138 were female(44.1%);181 were monocular and 132 were binocular.The international standard of intraocular RB staging(IIRC)was 6,13,6,52,227 and 9 patients of A,B,C,D,E and extraocular stages respectively.Among the 313 patients,245 patients were confirmed to the survivance,of which 22 cases(9.0%,22/245)died.Among 445 eyes,330 eyes definitely whether or not were enucleated;184 eyes had definite IIRC stage,eye examination results,definite treatment plan and times before enucleation and definite pathological tumor node metastasis stage after operation.The basic information,demographic characteristics,clinical information,enucleation and treatment plan,pathological and immunohistochemical results were recorded.Binary logistic regression was used to analyze the risk factors of high risk pathological features(HRF)and prognosis in patients with RB.Results From 1999 to 2018,the survival rate of 245 patients was increased from 82.6%to 96.3%year by year;the enucleation rate of 330 eyes with final enucleation was reduced from68.8%to 58.3%year by year.The rate of enucleation in stage D and stage E decreased from 83.3%and 100%before 2005 to 37.5%and 85.4%after 2014,respectively.Monocular disease(β=-1.551,P=0.005),stage D,stage E and extraocular stage in IIRC stage(P<0.005)were the independent risk factors of RB enucleation,while the protective factors were Interventional chemotherapy of ophthalmic artery(IAC)(β=-0.877,P<0.001).HRF was found in 51 eyes(27.7%).Age of onset(β=0.019,P=0.016)and glaucoma(β=0.816,P=0.050)were independent risk factors for HRF in RB pathology,while IAC treatment was the protective factor for enucleation(β=21.432,P<0

关 键 词：视网膜母细胞瘤/治疗 化学疗法 肿瘤 局部灌注 眼动脉 眼球摘除术 

分 类 号：R739.7[医药卫生—肿瘤]