术前化疗对眼内期视网膜母细胞瘤术后病理及预后的影响

Effects of pre-enucleation chemotherapy on pathological stage and prognosis of patients with intraocular retinoblastoma

目的探讨术前全身化疗对眼内期视网膜母细胞瘤（RB）术后眼球病理分级及生存率的影响。方法选取北京同仁医院儿科2008年1月-2009年12月术前临床诊断同时经眼球摘除后病理确诊的为D期及E期的223例RB患儿为研究对象。根据其病理分级标准肿瘤侵犯视神经的程度分为5级：0级为未侵犯视神经;1级为侵犯视乳头;2级为侵犯筛板;3级为侵犯筛板之后,未到视神经断端;4级为侵犯视神经断端。分别将D、E期患儿根据术前化疗与否分为2组：第一组术前未行化疗组;第二组术前化疗组（1～6个周期）。分析两组眼病理视神经侵犯程度及预后。结果 223例患儿共263只眼,其中D期68只眼,E期患儿155只眼,双眼中对侧眼A期28只眼,B期12只眼;双眼患儿40例,单眼183例;男148例,女95例;发病平均年龄24.4±17.0个月,中位发病年龄21个月。D期及E期患儿术前未行化疗组与化疗组眼病理视神经侵犯程度差异均具有显著性;D期患儿术前未行化疗组与化疗组眼病理肿瘤细胞穿过筛板发生率差异无显著性（P〉0.05）,而E期术前未行化疗组与化疗组眼病理肿瘤细胞穿过筛板发生率差异具有显著性（P〈0.05）。术后5年生存率D期为98.5%,E期为96.1%。D期及E期术前化疗组与未化疗组之间生存率差异无显著性（P〉0.05）。结论术前全身化疗是眼内期分期D、E期RB的术后病理分级的影响因素。对D、E期RB患儿术前行化疗与否并不影响患儿的总生存率。

Objective Pre-enucleation chemotherapy（PEC） for intraocular retinoblastoma may affect pathological stage and survival.Methods Two hundred and thirty-three children diagnosed with group D or E retinoblastoma between January 2008 and December 2009 at Beijing Tongren Hospital were included.The children were divided into non-PEC group,PEC group（1～6 cycles）.Pathological stage was based on the extent of optic nerve involvement.Pathological stage and prognosis were compared among the groups.The subjects were followed up for 5 years after enucleation.Results Of the 223 children（148boys and 95 girls）,68 were in group D and 115 were in group E.Mean age was 24.4 ± 17.0 months.For group D and E retinoblastoma,the extent of optic nerve involvement differed between non-PEC and PEC groups.Involvement of the optic nerve posterior to the ethmoid plate did not differ between non-PEC and PEC groups for group D retinoblastoma but did differ between those groups for group E retinoblastoma.Children with group D or E retinoblastoma had 5-year survival rates of 98.5%or 96.1%,respectively.Survival rates did not differ between non-PEC and PEC groups for either group D or E retinoblastoma.Conclusions PEC affected pathologic stage in children with group D and group E retinoblastoma,without improving survival rates.