视网膜母细胞瘤综合治疗的预后及其相关因素

Analysis of Prognostic Factors of Comprehensive Treatment on Retinoblastoma

目的：研究视网膜母细胞瘤（RB）患儿综合治疗的预后并探讨其相关临床因素。方法：回顾性系列病例研究。分析在深圳市眼科医院进行综合治疗的65例（92眼）RB患儿的临床资料。综合治疗的方法为以化疗为主联合局部治疗（光凝或冷冻）＋眼球摘除治疗。不同结局相关临床因素的比较采用独立样本t检验，其余指标采用Fisher＇s精准检验。结果：所有RB患儿的总生存率为92％，不同分期生存率差异无统计学意义。所有患儿总的保眼率为51％，E期和其他4期之间保眼率差异均有统计学意义（P〈0．01）。高风险D、E期RB患儿共60例，采用化疗联合局部治疗保眼的共42例，D期18例中11例保眼成功，E期24例中4例保眼成功。治疗成功与失败患儿的初诊时间和随访时间差异无统计学意义。根据眼内肿瘤的位置将42例患儿分为3组，分析显示即周边部（包括中周部）与后极部、后极部＋周边部保眼率差异有统计学意义（P=0．009、0．021）。42例患儿中4例死亡，均为肿瘤位置处于后极部的患儿，后极部与后极部＋周边部2组之间病死率差异有统计学意义（P=0．045）。结论：综合治疗提高了RB患儿的生存率，但患儿的生存率和保眼率与其临床分期及肿瘤所处的位置高度相关。

Objective： To characterize the comprehensive treatment of retinoblastoma （RB） and investigate the related clinical factors. Methods： In this retrospective study, clinical tiaras were analyzed for 65 cases （92 eyes） of childhood RB that received comprehensive treatment, including chemotherapy, local treatment （laser or cryotherapy）, and enucleation. Using t-test and Fisher＇s exact test to analyze the data. Results： The survival rate for the 65 cases was 92%. The eyeballs were preserved in 51% of the children. The rate of eyeball preservation in stage E group was significantly lower than the other four stage groups （P〈0.01）. Children in stage D group （18 cases） and stage E group （24 cases） were treated with chemotherapy combined with local therapy. The eyeballs were preserved in 11 cases in stage D groups and 4 cases in stage E groups. There were no significant differences in the clinical factors between eyeballs preserved or not children.The patients in stage D and E groups were further divided into three groups according to the location of the tumors in the eye： it showed peripheral retina （including the mid- peripheral retina） group with higher rate of eyeball preservation than the posterior pole retina and the posterior pole retina＋peripheral retina group （P=0.009, 0.021）. Four of the 42 patients died, all with tumors located in the posterior pole retina （P=0.045 compared to the peripheral retina and to the posterior pole retina＋peripheral retina）. Conclusions： Compr- ehensive treatment improved the survival and eyeball preservation rate of children with RB. The survival rates and eyeball preservation rates were closely related to the clinical stage.