视网膜母细胞瘤预后相关病理因素分析

Histopathologic risk factors for prognosis in patients with retinoblastoma

目的研究视网膜母细胞瘤患者预后的相关病理因素，探讨评估患者预后的病理学指标。方法对1995—2004年期间在中山大学中山眼科中心经眼球摘除并病理确诊的125例视网膜母细胞瘤单眼患者的临床病理资料和随访资料进行回顾性研究，应用Cox比例风险模型单因素和多因素分析影响预后的病理因素。结果视网膜母细胞瘤患者总体5年生存率为89％，单因素预后分析显示视神经断端浸润（χ^2=114．150，P=0．000）、巩膜浸润（χ^2=35．080，P=0．000）、眶组织浸润（χ^2=28．765，P=0．000）、虹膜浸润（χ^2=18．242，P=0．000）、睫状体浸润（χ^2=11．495，P=0．001）和角膜浸润（χ^2=10．240，P=0．001）为影响预后的重要因素；多因素预后分析显示视神经筛板后浸润（P=O．045，wald值4．013）和视神经断端浸润（P=0．000，Wald值37．559）为影响预后的重要因素。结论视网膜母细胞瘤病理检查有广泛脉络膜浸润、巩膜浸润、眶组织浸润、视神经筛板后浸润和视神经断端浸润是影响患者预后的重要危险因素。

Objective To define the histopathologic risk factors for prognosis in patients with retinoblastoma treated by eyeball enucleation.Methods Clinicopathologic data of 125 patients with unilateral retinoblastoma were retrospectively reviewed,and all of them were treated by eyeball enucleation between 1995 and 2004 in Zhongshan Ophthalmic Center, Sun Yat-sen University.The Cox regression model was used for multivariate and tmivariate analysis.Results The overall five-year survival rate was 89% for the 125 patients.The histopathologic factors significantly associated with poor prognosis for patients with retinoblastoma from univariate analysis included invasion to cut section of the optic nerve （χ^2 =114.150, P =0.000）、scleral invasion （χ^2 =35.080, P =0.000）, orbital invasion （χ^2 =28.765, P =0.000）, iris invasion （χ^2 = 18.242, P =0.000） ciliary body invasion（χ^2=11.495, P =0.001 ） ,corneal invasion（χ^2 =10.240, P =0.001 ）and factors independently associated with poor prognosis from a multivariate analysis were postlaminary optic nerve invasion （P =0. 045, wald value is 4.013 ）and involvement of optic nerve to transsection line （P=0.000, wald value is37.559）. Conclusion Massive choroidal invasion, scleral invasion、 orbital invasion、 postlaminary optic nerve invasion and optic nerve transsection line invasion were important prognostic factors in patients with retinoblastoma after eyeball enucleation.