视网膜母细胞瘤预后因素分析

Analysis of prognostic factors of retinoblastoma

目的探讨影响视网膜母细胞瘤（RB）患者预后的因素。方法前瞻性系列病例研究。采用免疫组织化学两步法检测31例手术摘除的RB患者标本神经元特异性烯醇化酶（NSE）、神经胶质原纤维酸性蛋白（GFAP）、S-100蛋白的表达，Spin-病理图像分析仪计数每例1000个肿瘤细胞中NSE阳性的细胞数，对GFAP、S-100蛋白染色阳性的细胞进行定量，全部随访5—17年，采用Cox回归模型分别将性别、年龄、临床分期、分化类型、NSE计数、GFAP、S-100蛋白染色定量、治疗方法与预后进行分析；Spearman法分析等级相关因素，t检验用于两均数的比较。结果（1）NSE在31例RB标本中均有不同程度表达，GFAP染色阳性19例，阳性率61．29％（19／31），S-100蛋白染色阳性18例，阳性率58．06％（18／31）；NSE阳性数值越高、GFAP及S-100蛋白染色定量分级越高，预后越好（P=0．0361，0．0430，0．0477）。（2）术后生存时间≥5年患者的NSE平均计数（324／1000）高于术后生存时间〈5年患者的NSE平均计数（182／1000），差异有统计学意义（t=3．602，P〈0．01）。（3）NSE计数与GFAP及S-100蛋白染色定量的结果密切相关（r=0．547，0．581）。结论（1）RB患者标本的NSE染色阳性瘤细胞计数值越高，生存率越高。（2）GFAP及S-100蛋白在RB中的表达与预后呈正相关。（3）NSE染色阳性细胞计数、GFAP、S-100蛋白染色分级可作为评估RB患者预后的组织学参数之一.

Objective To study the prognostic factors of retinoblastoma （RB）. Methods Prospective case series study. With Envision System, surgical specimens from 31 RB cases were immunostained by using anti-NSE, GFAP and S-100 antibodies. Number of NSE positive cells was counted at 1000 tumor cells in each slice. The morphology of GFAP and S-100 stained positive cells were analyzed. All cases were followed-up for 5 to 17 years. Cox regression pattern was adopted to analyze the relationship between sex, age, stage, differentiation, number of NSE positive cells, the sizes of GFAP and S-100 positive cells, therapies and prognosis. Results （ 1 ） Almost all cases were stained positively by anti-NSE antibodies. Positive rates of GFAP and S-100 expression specimens were 61.29% （ 19/31 ） and 58. 06% （18/31）, respectively. （2）The number of NSE positive cells was correlated with a better prognosis （P = 0. 0361 ）. The sizes of GFAP and S-100 stained area were also related with a better progress （P = 0. 0430, 0. 0477）. In patients with a greater number of NSE stained cells （averaged 324/1000）, the survival time was ≥5 years. In patients with a less number of NSE stained cells （averaged 182/1000）, the survival time was less than 5 years. （3） There was a significant correlation between the number of NSE stained cells and the results for GFAP and S-100 staining （ r =0. 547, 0. 581 ）, respectively. Conclusions The number of NSE positive cells is correlated with a better prognosis of RB. The expression of GFAP and S-100 protein are also correlated with a better prognosis of RB. The number of NSE positive ceils and the expression of GFAP and S-100 protein may be regarded as the standards in judging the degree of differentiation of RB, and may be used as one of criteria for the estimation of the prognosis.