118例视网膜母细胞瘤临床治疗分析

郝冰; 李佳; 李秀红; 石安杰; 刘志彬; 袁洪峰

doi:10.16016/j.1000-5404.202001051

您当前的位置：

首页 >

文章列表页 >

118例视网膜母细胞瘤临床治疗分析

临床医学 | 更新时间：2026-01-09

- 118例视网膜母细胞瘤临床治疗分析
- Clinical treatment for retinoblastoma: report of 118 cases
- 第三军医大学学报 2020年42卷第9期页码：942-947
- 作者机构：
  
  400042 重庆，陆军军医大学(第三军医大学)大坪医院眼科
- 作者简介：
  
  [ 袁洪峰, E-mail:yhf871@sina.com YUAN Hongfeng, E-mail:yhf871@sina.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202001051
  中图分类号： R181.32;R739.72
- 收稿：2020-01-07，
  
  修回：2020-02-25，
  
  纸质出版：2020-05-15
- 稿件说明：
移动端阅览
郝冰, 李佳, 李秀红, 等. 118例视网膜母细胞瘤临床治疗分析[J]. 第三军医大学学报, 2020,42(9):942-947.

Bing HAO, Jia LI, Xiuhong LI, et al. Clinical treatment for retinoblastoma: report of 118 cases[J]. Journal of Third Military Medical University, 2020, 42(9): 942-947.
郝冰, 李佳, 李秀红, 等. 118例视网膜母细胞瘤临床治疗分析[J]. 第三军医大学学报, 2020,42(9):942-947. DOI： 10.16016/j.1000-5404.202001051.

Bing HAO, Jia LI, Xiuhong LI, et al. Clinical treatment for retinoblastoma: report of 118 cases[J]. Journal of Third Military Medical University, 2020, 42(9): 942-947. DOI： 10.16016/j.1000-5404.202001051.

摘要

目的

探讨118例视网膜母细胞瘤(retinoblastoma

RB)临床治疗特点及预后。

方法

以2008年2月至2018年2月我科收治的118例RB病例为研究对象，按IIRC(A~E期)和眼外期标准对患眼进行分期，主要根据肿瘤的分期，同时结合患儿身体状况及患儿家长意愿采用静脉化疗、经瞳孔温热疗法(transpupillary thermotherapy

TTT)、冷凝疗法、眼球摘除等方式治疗，随访1~10年，回顾性分析患儿的临床疗效及预后。

结果

118例患儿共154眼，双眼36例，单眼82例，男性70例，女性48例。初诊患儿年龄1~122(25.94±20.88)个月。化疗41例，化疗联合TTT治疗57例，化疗联合冷凝治疗10例，单纯眼摘10例。154眼治疗后保76眼，总保眼率49.35%(76/154)，其中采用化疗联合TTT治疗保47眼，占总保眼数61.84%(47/76)。手术摘除78眼，总摘眼率50.65%(78/154)，E期手术摘53眼，占E期患眼84.13%(53/63)。118例患儿随访时间(86.66±5.69)个月，死亡22例，总死亡率18.64%(22/118)；存活96例，总存活率81.36%(96/118)；单眼RB 5年累积生存率为71.40%，双眼RB 5年累积生存率为80.00%。

结论

静脉化疗联合TTT治疗是RB患儿保眼球的主要治疗方式，眼球摘除仍然是E期的主要治疗方式，E期RB患儿应慎重选择保眼治疗。

Abstract

Objective

To investigate the characteristics of clinical treatment and prognosis of 118 cases of retinoblastoma (RB).

Methods

A total of 118 RB children treated in our department from February 2008 to February 2018 were recruited in this study. All of them were evaluated by the International Classification for Intraocular Retinoblastoma (IIRC

A~E stage) and extraocular staging standard. Mainly according to their tumor stage

combined with their physical condition and the wishes of their parents

treatments such as intravenous chemotherapy

transpupillary thermotherapy (TTT)

freezing and enucleation were applied. All cases were followed up for 1 to 10 years

and the clinical efficacy and prognosis of the patients were analyzed retrospectively.

Results

The 118 enrolled children (154 eyes) were 70 males and 48 females

at an average age of 25.94±20.88 months (1~122 months) at first visit

and 36 of them suffered from bilateral RB and 82 from single. Among them

41 received chemotherapy

57 chemotherapy combined with TTT

10 chemotherapy combined with freezing

and 10 enucleation only. After treatment

76 eyes (76/154) were salvaged

with a total salvage rate of 49.35%

and of them

47 eyes were treated with chemotherapy combined with TTT

accounting for 61.84% (47/76). Seventy-eight eyes were enucleated

with a total extraction rate of 50.65% (78/154)

and among 63 eyes at stage E

53 were enucleated

accounting for 84.13%. During the mean follow-up time of 86.66±5.69 months

22 (18.64%) children died

and 96 cases (81.36%) survived. The 5-year cumulative survival rate of single eye was 71.40%

and of bilateral was 80.00%.

Conclusion

Intravenous chemotherapy combined with TTT is one of the main ways for RB salvage. Enucleation is still the primary treatment for stage E eyes.

关键词

Keywords

references

ABRAMSON D H, SCHEFLER A C. Update on retinoblastoma[J]. Retina (Philadelphia, Pa.), 2004, 24(6): 828-848. DOI:10.1097/00006982-200412000-00002.

KNUDSON A G Jr. Mutation and cancer: statistical study of retinoblastoma[J]. Proc Natl Acad Sci USA, 1971, 68(4): 820-823. DOI:10.1073/pnas.68.4.820.

BROADDUS E, TOPHAM A, SINGH A D. Incidence of retinoblastoma in the USA: 1975-2004[J]. Br J Ophthalmol, 2009, 93(1): 21-23. DOI:10.1136/bjo.2008.138750.

ORTIZ M V, DUNKEL I J.Retinoblastoma[J]. J Child Neurol, 2016, 31(2):227-236.

SHIELDS C L, SHELIL A, CATER J, et al . Development of new retinoblastomas after 6 cycles of chemoreduction for retinoblastoma in 162 eyes of 106 consecutive patients[J ] . Arch Ophthalmol, 2003, 121(11): 1571-1576. DOI:10.1001/archopht.121.11.1571.

DEMIRCI H, EAGLE R C Jr, SHIELDS C L, et al . Histopathologic findings in eyes with retinoblastoma treated only with chemoreduction[J ] . Arch Ophthalmol, 2003, 121(8): 1125-1131. DOI:10.1001/archopht.121.8.1125.

ZHAO J Y, LI S F, SHI J T, et al . Clinical presentation and group classification of newly diagnosed intraocular retinoblastoma in China[J ] . Br J Ophthalmol, 2011, 95(10): 1372-1375. DOI:10.1136/bjo.2010.191130.

DIMARAS H, KIMANI K, DIMBA E A, et al . Retinoblastoma[J ] . Lancet, 2012, 379(9824): 1436-1446. DOI:10.1016/s0140-6736(11)61137-9.

SEREGARD S, LUNDELL G, SVEDBERG H, et al . Incidence of retinoblastoma from 1958 to 1998 in Northern Europe: advantages of birth cohort analysis[J ] . Ophthalmology, 2004, 111(6): 1228-1232. DOI:10.1016/j.ophtha.2003.10.023.

KIVELÄ T. The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death[J]. Br J Ophthalmol, 2009, 93(9): 1129-1131. DOI:10.1136/bjo.2008.150292.

LEAL-LEAL C. A multicentre report from the Mexican Retinoblastoma Group[J]. Br J Ophthalmol, 2004, 88(8): 1074-1077. DOI:10.1136/bjo.2003.035642.

NASERIPOUR M, NAZARI H, BAKHTIARI P, et al . Retinoblastoma in Iran: outcomes in terms of patients' survival and globe survival[J ] . Br J Ophthalmol, 2009, 93(1): 28-32. DOI:10.1136/bjo.2008.139410.

CHANG C Y, CHIOU T J, HWANG B, et al . Retinoblastoma in Taiwan: survival rate and prognostic factors[J ] . Jpn J Ophthalmol, 2006, 50(3): 242-249. DOI:10.1007/s10384-005-0320-y.

SWAMINATHAN R, RAMA R, SHANTA V. Childhood cancers in Chennai, India, 1990-2001: incidence and survival[J]. Int J Cancer, 2008, 122(11): 2607-2611. DOI:10.1002/ijc.23428.

BOWMAN R J, MAFWIRI M, LUTHERT P, et al . Outcome of retinoblastoma in east Africa[J ] . Pediatr Blood Cancer, 2008, 50(1): 160-162. DOI:10.1002/pbc.21080.

ROARTY J D, MCLEAN I W, ZIMMERMAN L E. Incidence of second neoplasms in patients with bilateral retinoblastoma[J]. Ophthalmology, 1988, 95(11): 1583-1587. DOI:10.1016/s0161-6420(88)32971-4.

ABRAMSON D H, DUNKEL I J, BRODIE S E, et al . A phase I/Ⅱ study of direct intraarterial (ophthalmic artery) chemotherapy with melphalan for intraocular retinoblastoma[J ] . Ophthalmology, 2008, 115(8): 1398-1404.e1. DOI:10.1016/j.ophtha.2007.12.014.

FRIEDMAN D L, HIMELSTEIN B, SHIELDS C L, et al .Chemoreduction and local ophthalmic therapy for intraocular retinoblastoma[J ] . J Clin Oncol, 2000, 18(1):12-17.

SHIELDS C L, MASHAYEKHI A, AU A K, et al . The International Classification of Retinoblastoma predicts chemoreduction success[J ] . Ophthalmology, 2006, 113(12): 2276-2280. DOI:10.1016/j.ophtha.2006.06.018.

梁建宏, 黎晓新, 尹虹, 等.视网膜母细胞瘤患者全身化学药物治疗联合眼部治疗的临床疗效观察[J].中华眼底病杂志, 2007(5): 332-335.

LIANG J H, LI X X, YIN H, et al . Therapeutic effect of chemotherapy combined with ophthalmic therapy on retinoblastoma[J ] . Chin J Ocular Fundus Dis, 2007(5): 332-335.

BRENNAN R C, QADDOUMI I, BILLUPS C A, et al . Comparison of high-risk histopathological features in eyes with primary or secondary enucleation for retinoblastoma[J ] . Br J Ophthalmol, 2015, 99(10): 1366-1371. DOI:10.1136/bjophthalmol-2014-306364.

SURYAWANSHI P, RAMADWAR M, DIKSHIT R, et al . A study of pathologic risk factors in postchemoreduced, enucleated specimens of advanced retinoblastomas in a developing country[J ] . Arch Pathol Lab Med, 2011, 135(8): 1017-1023. DOI:10.5858/2010-0311-OAR2.

李彬, 顼晓琳.评估视网膜母细胞瘤临床组织病理学高危因素的重要性及需关注的问题[J].中华眼科杂志, 2014(10):725-728.

LI B, XIANG X L. The importance of evaluating histopathologic high risk factors in retinoblastoma and the related issues[J]. Chin J Ophthalmol, 2014(10):725-728.

SHIELDS C L, MASHAYEKHI A, CATER J, et al . Chemoreduction for retinoblastoma. Analysis of tumor control and risks for recurrence in 457 tumors[J ] . Am J Ophthalmol, 2004, 138(3): 329-337. DOI:10.1016/j.ajo.2004.04.032.

TURAKA K, SHIELDS C L, MEADOWS A T, et al . Second malignant neoplasms following chemoreduction with carboplatin, etoposide, and vincristine in 245 patients with intraocular retinoblastoma[J ] . Pediatr Blood Cancer, 2012, 59(1): 121-125. DOI:10.1002/pbc.23278.

BENZ M S, SCOTT I U, MURRAY T G, et al . Complications of systemic chemotherapy as treatment of retinoblastoma[J ] . Arch Ophth almol, 2000, 118(4): 577-578.

BERRY J L, JUBRAN R, KIM J W, et al . Long-term outcomes of Group D eyes in bilateral retinoblastoma patients treated with chemoreduction and low-dose IMRT salvage[J ] . Pediatr Blood Cancer, 2013, 60(4): 688-693. DOI:10.1002/pbc.24303.

FABIAN I D, STACEY A W, JOHNSON K P, et al . Primary intravenous chemotherapy for group D retinoblastoma: a 13-year retrospective analysis[J ] . Br J Ophthalmol, 2017, 101(1): 82-88. DOI:10.1136/bjophthalmol-2016-309710.

KVNKELE A, JURKLIES C, WIELAND R, et al . Chemoreduction improves eye retention in patients with retinoblastoma: a report from the German Retinoblastoma Reference Centre[J ] . Br J Ophthalmol, 2013, 97(10): 1277-1283. DOI:10.1136/bjophthalmol-2013-303452.

胡慧敏, 张伟令, 王一卓, 等.视网膜母细胞瘤远处转移期的临床特点和治疗及预后分析[J].中华眼科杂志, 2017, 53(2):121-127. DOI:10.3760/cma.j.issn.0412-4081.2017.02.010.

HU H M, ZHANG W L, WANG Y Z, et al . Clinical features, treatment and prognosis of retinoblastoma in distant metastasis stage[J ] . Chin J Ophthalmol, 2017, 53(2): 121-127. DOI:10.3760/cma.j.issn.0412-4081.2017.02.010.

钱江, 薛康.晚期视网膜母细胞瘤可否保眼治疗[J].中华眼科杂志, 2016, 52(10): 728-732.DOI:10.3760/cma.j.issn.0412-4081.2016.10.003.

QIAN J, XUE K. Eyeball salvage treatment or enucleation for advanced retinoblastoma[J]. Chin J Ophthalmol, 2016, 52(10): 728-732. DOI:10.3760/cma.j.issn.0412-4081.2016.10.003.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

卵巢恶性生殖细胞瘤患儿62例治疗结果分析

免疫治疗联合靶向治疗及化疗在微卫星稳定型转移性结直肠癌患者三线治疗中的疗效和安全性

膀胱部分切除术与根治性全膀胱切除术治疗局限性肌层浸润性膀胱癌的临床分析

肺腺癌A549细胞中TNIK通过Rho/ROCK/LIMK1调控微丝骨架形态

氧化铱纳米载药复合物的制备及其用于肿瘤声动力-化疗协同治疗的研究