摘要
目的分析视网膜母细胞瘤(retinoblastoma,Rb)侵犯眼球部位与患者预后之间的关系,为病情的预测和治疗提供依据。方法回顾性分析2003年1月至2011年2月于中山大学中山眼科中心行眼球摘除术的单眼Rb患者。记录术后肿瘤侵犯的部位、治疗情况和生存情况并评估患者的5a生存率(5year probability event-free survival,5-PEFS)。随访以患者死亡或至2012年2月截止,随访时间为(46.3±29.2)个月。结果共有202例202眼患者纳入研究,其中筛板及筛板前侵犯所占比例最大(40.6%),5-PEFS也最高(96.1%);筛板后视神经侵犯和视神经断端侵犯者5-PEFS分别是82.5%和40.0%,三者比较差异有显著统计学意义(P〈0.01)。筛板后视神经侵犯接受治疗的患者5-PEFS(91.6%)有高于未治疗者(66.7%)的趋势(P=0.09);视神经断端侵犯者接受治疗与未治疗的5-PEFS分别是50.0%和0(P〈0.01),单纯脉络膜侵犯患者5-PEFS是93.8%,巩膜侵犯患者接受和未接受辅助化疗的5-PEFS分别是57.1%和77.8%(P〉0.05)。2例眼眶侵犯患者均死亡,4例患者眼球摘除术后眼眶复发,从眼球摘除术到眼眶复发的时间是5—15个月,平均为9.8个月。结论Rb眼球摘除术后病理检查对患者预后的预测和辅助治疗有指导意义;眼球摘除术后2a,尤其1a内是Rb复发的高发期,这期间所有患者需要密切随诊。
Objective To analyze the relationship between eyeball invasive locations and prognosis of retinoblastoma for metastasis after enucleation, and offer a reliable guide to adjuvant therapy. Methods Retrospective study was done about patients with unilateral retinoblastoma treated by enucleation without prior treatment at Zhongshan Ophthalmic Center of Sun Yat-Sen University between January 2003 and February 2011. The locations of tumor invasion,treatment and survival condition of patients were recorded, and the 5-PEFS ( 5 year probability event-free survival) was calculated. Follow-up visit ended until patients died or by February 2012. The follow-up period was (46.3± 29.2) months. Results A total of 202 eyes of 202 patients were enrolled in this study. The patients with the laminar or prelaminar involvement accounted for the largest proportion (40.6%) ,which had the highest 5-PEFS (96.1%). The 5-PEFS of the patients with post-laminar optic nerve involvement and transection line of optic nerve involvement were 82.5% and 40.0% , respectively. The patients with post-laminar optic nerve involvement accepted adjuvant chemotherapy had a tendency of higher 5- PEFS (91.6%)than that of untreated patients (66.7% ,P =0.09). The 5-PEFS of patients accepted treatment with transection line of optic nerve involvement significant higher than that of untreated patients(P 〈 0. 01 ). The 5-PEFS of patients with isolated choroid invasion was 93.8%. The 5-PEFS of patients with tumor invasion to sclera who received adjuvant chemotherapy and that of those did not receive adjuvant chemothera- py were respectively 77.8% and 57. 1% ( P 〉 0.05 ). Two patients with orbit invaded died. Four of 202 patients recurrented in orbit after enucleation. The average time from enucleation to relapse was 9.8 months (5 - 15 months). Conclusion Histopathology after enucleation may provide a reference to prognosis and adjuvant therapy. Almost all recurrences of retinoblastoma occur within 2 years, especially 1 year, after enucleation, during which all retinoblastoma patients have to keeping close follow-up.
出处
《眼科新进展》
CAS
北大核心
2014年第12期1147-1151,共5页
Recent Advances in Ophthalmology
基金
广东省科技计划项目基金资助(编号:2008B030301069)~~