视网膜母细胞瘤眼球摘除术后病理与预后分析

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（５ｙｅａｒｐｒｏｂａｂｉｌｉｔｙｅｖｅｎｔ-ｆｒｅｅｓｕｒｖｉｖａｌ，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。

Analysis of histopathology and prognosis of retinoblastoma after enucleation

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 sigruficant 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 chemotherapy were respectively 77. 8% and 57. 1% ( P > 0. 05 ) . TAro 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) . Conclrision Histopathology after enucleation may provide a reference to prognosis and adjuvant therapy. Almost all recurrences of retinoblastoma occur within 2 years , especially I year , after enucleation. during which all retinoblastoma patients have to keeping close follow-up.