视网膜母细胞瘤细胞分化程度对扩散和存活预后的影响

Relationship of differentiated degree with spread or survival prognosis in retinoblastoma

目的 探讨视网膜母细胞瘤 (retinoblastoma,RB)细胞分化程度对扩散和存活预后的影响。 方法 对 15 6份 RB眼球标本进行组织病理学观察 ,根据肿瘤细胞分化程度将其分为分化型与未分化型 ,注意有无肿瘤细胞的扩散 ,并统计两型发生扩散的比率。对随访到的 82例 RB患者进行死亡率统计。用χ2 检验的方法比较两型间死亡率和扩散发生率。记录扩散部位与死亡率之间的关系、死者生前眼球摘除术后平均存活时间。 结果 分化型 RB17例 17只眼 ,发生肿瘤细胞局部扩散 8只眼 ,占 47.0 6 % ;未分化型 137例 139只眼 ,发生局部扩散 6 6只眼 ,占 47.48%。两型间发生扩散的比率差异无显著性意义 (P>0 .0 5 )。随访到的患者中 ,分化型 RB死亡率 2 7.2 7% ,未分化型 RB死亡率 2 2 .5 4% ,二者比较差异亦无显著性意义(P>0 .0 5 )。眶内和巩膜侵犯者死亡率 10 0 % ,视神经侵犯 级者死亡率 6 2 .5 0 % ,葡萄膜侵犯者死亡率2 2 .2 2 %。眼球摘除术后生存时间为 5～ 41个月 ,平均 2 1.92个月。 结论 分化型与未分化型 RB的存活预后及局部扩散比率差异无显著性意义。发生扩散的 RB,无论是分化型还是未分化型其预后均取决于扩散的程度以及是否进行积极治疗。

Objective To probe the relationship of differentiation degree with spread or survival prognosis in retinoblastoma (RB). Methods Clinical data, follow up status and eyeball specimens in 156 RB cases were investigated retrospectively. The tumors were divided into differentiated and undifferentiated groups.Conditions of the tumor invasion of ocular or surrounding tissues were reviewed. The fatality rate was obtained from the follow-up materials of 82 cases of RB. The fatality rate and the invasion rate between the two types were compared statistically by Chi-square test. In addition, the relation between the tumor invasion and death ,and the average survival time for dead people after surgery were explored. Results Local invasion of tumor cell was found in 8 eyes among 17 eyes with differentiated RB (47.06%),and in 66 eyes among 139 eyes with undifferentiated RB (47.48%).There was no significant difference with regards to the local invasion between the two types (P>0.05). The fatality rate of cases of differentiated RB was 27.27%,and 22.54% in undifferentiated RB, and there was no statistical difference between the two types .The fatality rate for patients with orbital and scleral extension was 100%,optic nerve invasion (grade Ⅳ) was 62.50%,and uveal invasion was 22.22%.The survival time for the dead victims were from 5 months to 41 months and averaged to 21.92 months. Conclusion There was no significant difference both in survival prognosis and local invasion between the two types. The survival prognosis of metastatic RB was dependent on the degree of spread and the efforts of treatment and regardless of the types of differentiation of RB cells.