视网膜母细胞瘤综合治疗的预后及其相关因素

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期之问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。

Analysis of Prognostic Factors of Comprehensive Treatment on Retinoblastoma

Objective: To characterize the comprehensive treatment of retinoblastoma (RB) and investigate the related clinical factors. Methods: In this retrospective study, clinical datas 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.