经眼动脉灌注化疗治疗视网膜母细胞瘤320例的临床研究

The clinical study of Intra-arterial Chemotherapy in 320 patients with Retinoblastoma

目的探讨经眼动脉灌注化疗(intra-arterial chemotherapy,IAC)治疗视网膜母细胞瘤(retinoblastoma,RB)患儿长期的保眼率、生存率及影响保眼率的因素。方法回顾性分析广州市妇女儿童医疗中心2009年4月至2016年4月介入血管瘤科收治行IAC治疗的视网膜母细胞瘤患儿,对其临床特征、治疗情况、患者保眼率及生存率进行研究;采用Kaplan-Meier法绘制保眼率生存曲线与生存曲线,对性别、国际眼内RB肿瘤的分级、年龄、术前的治疗史等因素与保眼率的关系进行单因素分析,用COX比例风险模型探讨RB预后影响因素。结果共有320例患儿纳入研究。307例(374只患眼)存活患儿IAC术后中位随访时间为40个月(1~130个月),经眼动脉灌注化疗共1299次(平均3.47次)。存活患儿自最后一次IAC治疗日开始,RB患儿最短保眼时间1个月,最长保眼时130个月,术后284只患眼瘤体稳定眼球未摘除,总体保眼率为75.9%;根据IIRC分期,A期(n=1)、B期(n=23)、C期(n=25)、D期(n=258)、E期(n=67)RB患者随访时间内保眼率分别为100%、95.7%、100%、80.6%、41.8%。经单因素分析结果显示,临床分期与RB患儿保眼率有统计学关联。多因素COX回归分析显示IIRC分期(RR72.7)是RB患者保眼率的影响因素。随访期间共13例因疾病进展而死亡,生存率96.0%。结论IAC治疗RB可以显著提高保眼率,长期疗效肯定。肿瘤分期是影响其保眼率的重要因素。

Objective To explore the long-term globe salvage rate,life survival rate and the risk factors affecting the globe salvage in retinoblastoma(RB)patients treated with Intra-arterial chemotherapy(IAC).Method The retrospective cohort study was conducted among patients with RB underwent IAC in Guangzhou woman and children hospital from April 2009,to April 2016.The clinical characteristics,treatment situation,globe salvage rate and life survival rate were analysis.The Kaplan Meier survival curve was used to estimate globe survival time and life survival time for patient and univariate analysis was performed to explore the relationship between globe salvage rate and gender,IIRC,age,preoperative treatment history.Cox proportional hazard model was conducted to identify the determinants of prognosis for patients with RB.Results A total of 320 cases were included.The median follow-up time of 307 surviving patients(374 eyes)after IAC was 40 months(1 to 130 months),There were 1299 IAC(average 3.47 times per eye).From the last IAC treatment,the shortest globe salvage time for RB children was 1 month,and the longest globe salvage time was 130 months.284 patients’eyeball was not removed due to stable disease.The overall globe salvage rate was 75.9%.The globe salvage rate in stage A(n=1),stage B(n=23),stage C(n=25),stage D(n=258),stage E(n=67)were 100%,95.7%,100%,80.6%,41.8%,respectively.Univarite analysis showed that the salvage rate was significantly associated with IIRC.Multivariate analysis of Cox proportional hazard model showed that IIRC(RR 72.7)were independent determinant for RB globe salvage rate.13 patients died due to the disease progression during follow-up(survival rate 96.0%).Conclusions Intra-arterial chemotherapy is safe and effective for management of retinoblastoma in the long term.IIRC can be used for the assessment of prognosis.