单中心157例视网膜母细胞瘤患者综合治疗回顾性临床研究  

A single-center retrospective clinical study on comprehensive treatment for 157 patients with retinoblastoma

作　　者：邹弋华 季迅达[1] 李家恺[1] 梁庭溢 华续明[2] 赵培泉[1] Zou Yihua;Ji Xunda;Li Jiakai;Liang Tingyi;Hua Xuming;Zhao Peiquan(Department of Ophthalmology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Neurosurgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院眼科,上海200092 [2]上海交通大学医学院附属新华医院神经外科,上海200092

出　　处：《中华眼底病杂志》2023年第10期810-816,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金(82171069)。

摘　　要：目的观察视网膜母细胞瘤(RB)患儿综合治疗的疗效和安全性。方法回顾性临床研究。2019年1~12月于上海交通大学医学院附属新华医院眼科检查确诊且行综合治疗的RB患儿157例203只眼纳入研究。其中,男性76例,女性81例;单眼111例,双眼46例。诊断月龄中位数20.1个月。均为初次接受治疗者。肿瘤局限于眼内者依据国际眼内RB分期标准分为A~E期以及眼外期、远处转移期。中位随访时间37.4个月。记录患儿临床特征、治疗方案、预后及眼部治疗并发症发生情况。结果157例203只眼中,眼内期137例180只眼,其中A~E期分别为6、14、10、98、52只眼;眼外期12例12只眼;远处转移期8例11只眼。全身转移死亡8例;生存149例(94.9%,149/157)。眼球摘除48只眼,其中初始治疗眼球摘除34只眼,经保眼治疗后眼球摘除14只眼;未行眼球摘除155只眼(76.4%,155/203)。保眼治疗后保眼率为91.7%(155/169)。双眼患者取分期更严重眼进行统计分析,初始保眼治疗120例120只眼,其中经静脉化学药物治疗(IVC)、眼动脉灌注化学药物治疗(IAC)分别为36、84只眼。两种治疗方案的眼球摘除分别为7(19.4%,7/36)、7(8.3%,7/84)只眼;接受二次治疗分别为33(91.7%,33/36)、33(39.3%,33/84)只眼。两种治疗方案的眼球摘除率比较,差异无统计学意义(χ^(2)=2.037,P=0.154);接受二次治疗百分率比较,差异有统计学意义(χ^(2)=27.937,P<0.001)。初始治疗后瘤体消退并稳定54只眼(45.0%,54/120);因治疗反应差、肿瘤复发等原因接受二次治疗66只眼(55.0%,66/120)。行二次治疗的66只眼中,眼球摘除、IAC、玻璃体腔注射化学药物治疗(IVitC)、IAC联合IVitC、单纯局部治疗分别为6、18、12、13、17只眼;IAC、IVitC、IAC联合IVitC治疗眼中眼球摘除分别为5(27.8%,5/18)、1(9.3%,1/12)、2(15.4%,2/13)只眼,三者眼球摘除率比较,差异无统计学意义(χ^(2)=2.001,P=0.368)。末次随访有视力记录者148只眼(72.9%,148/2Objective To evaluate the efficacy and safety of comprehensive treatment for retinoblastoma(RB).Methods A retrospective clinical study.From January to December in 2019,157 cases(203 eyes)of RB who were diagnosed by the Department of Ophthalmology of Xinhua Hospital and received comprehensive treatment were included in this study.Of cases,76 were male,and 81 were female;111 were unilateral,and 46 were bilateral.The medium of age at diagnosis was 20.1 months.All patients received treatment for the first time.Patients with intraocular tumors were divided into A-E stages,extraocular stage and distant metastasis according to international intraocular RB classification standard.The median follow-up time was 37.4 months.Clinical features,treatment,prognosis and ocular complications of all cases were recorded.Results Among 157 cases(203 eyes),137 cases(180 eyes)were in intraocular stage;6,14,10,98,and 52 of eyes were in A-E stages,respectively.Twelve cases(12 eyes)were in extraocular stage;8 cases(11 eyes)were in distant metastasis stag;8 cases died due to distant metastasis;149 cases(94.9%,149/157)survived;48 eyes were enucleated,34 of which underwent initial enucleation,and 14 eyes underwent enucleation after eyepreserving treatment.The overall global salvage rate was 155 eyes(76.4%,155/203),and that after eyepreserving treatment was 91.7%(155/169).Severer eye for bilateral cases was taken into account for statistic;120 cases(120 eyes)received initial eye-preserving treatment.Among them,36 and 84 eyes underwent initial intravenous chemotherapy(IVC)and initial intra-arterial chemotherapy(IAC),respectively.The enucleation of the two groups was 7(19.4%,7/36),7(8.3%,7/84);33(91.7%,33/36)and 33(39.3%,33/84)eyes received the second treatment,respectively.There was no significant difference in the rate of enucleation between the two treatments(χ^(2)=2.037,P=0.154).There was significant difference in the percentage of secondary treatment(χ^(2)=27.937,P<0.001).Fifty-four eyes(45.0%,54/120)stabilized after initial treatment,an

关 键 词：视网膜母细胞瘤 综合治疗 经静脉化学药物治疗 经眼动脉灌注化学药物治疗 玻璃体腔注射化学药物治疗 

分 类 号：R739.7[医药卫生—肿瘤]