视网膜母细胞瘤的发病年龄及分化程度在评价患者预后中的地位

目的探讨视网膜母细胞瘤(Retinoblastoma,RB)患儿发病年龄与肿瘤细胞分化程度及其与预后的关系.方法光镜下观察291名患儿的297只眼球的病理切片,并追踪观察患儿的预后.将肿瘤细胞的分化程度分为四级,即肿瘤细胞完全未分化(Do);分化的肿瘤细胞所占的范围<1/3肿瘤面积(D1);1/3～2/3肿瘤面积(D2);>2/3肿瘤面积(D3).结果年龄小于6个月,肿瘤细胞分化最好(D3),年龄介于6～1 2个月者,肿瘤细胞分化较好(D2),年龄大于36个月,肿瘤细胞分化不良(D1),年龄介于24～30个月者,肿瘤细胞未分化(Do).四名1 5～24个月的患儿死于肿瘤细胞转移,肿瘤细胞分化程度在Do-D1.结论2岁以前患儿肿瘤细胞的分化程度较高.若在此年龄段患儿的肿瘤细胞分化不良,又同时伴有脉络膜浸润和/或视神经浸润,应视为预后不好的指征.

The age and differentiation degree of retinoblastoma

Objective: To study the relationships among age, differentiation degree and prognosis of retinoblastoma. Methods: Pathological sections from 297 eyes in 291 cases of retinoblastoma were observed with light microscope and followed up. The differentiation degrees of tumor cells were divided into 4 ranks: Do, the tumor cells were complete indifferent; D1, the limits of differentiated tumor cells <1/3 area of tumor; D2, 1/3~2/3 area of tumor; D3, the limits of differentiated cells > 2/3. Results: The patients with age younger than 6 months had the best differentiated tumor (D3), the age between 6-12 months had better differentiated tumor (D2), for those age over 36 months had less differentiated tumor (D1), age 24-30 months, however, had undifferentiated tumor (Do). Four children with age 15-24 months were died of tumor metastasis, their tumor differentiation degrees were Do~D1. Conclusions: The retinoblastoma cells of children with age before 2 years were good differentiated. If the tumor cells in this age phase were little differentiated and accompanied with choroidal invasion and/or optic nerve infiltration, it was regarded as indication for poor prognosis.