中华眼科杂志
中華眼科雜誌
중화안과잡지
Chinese Journal of Ophthalmology
2012年
7期
625-630
,共6页
薛康%钱江%岳晗%袁一飞%张锐
薛康%錢江%嶽晗%袁一飛%張銳
설강%전강%악함%원일비%장예
视网膜母细胞瘤%抗肿瘤联合化疗方案%冷冻疗法%肿瘤消退,自行性%预后
視網膜母細胞瘤%抗腫瘤聯閤化療方案%冷凍療法%腫瘤消退,自行性%預後
시망막모세포류%항종류연합화료방안%냉동요법%종류소퇴,자행성%예후
Retinoblastoma%Antineoplastic combined chemotherapy protocols%Cryotherapy%Neoplasm regression,spontaneous%Prognosis
目的 探讨视网膜母细胞瘤(RB)化学减容加局部治疗后的临床消退模式及预后.方法 回顾性系列病例研究.分析2005年1月至2009年6月间于复旦大学附属眼耳鼻喉科医院接受化学减容加局部治疗的RB患儿37例47只眼,122个RB瘤体.其中男性27例,女性10例.平均年龄为22个月.化学减容加局部治疗以长春新碱、依托泊甙、卡铂联合应用方案化学减容,辅以冷冻、经瞳孔温热疗法等局部巩固治疗.随访时间为12～60个月,平均32个月.视网膜母细胞瘤的消退模式包括0型:完全消退无痕迹；1型:完全钙化；2型:无钙化；3型:部分钙化；4型:萎缩瘢痕.对于存在家族史与否的患儿每只眼瘤体数的统计学差异采用秩和检验,对于不同肿瘤厚度及肿瘤位置肿瘤消退模式的差异采用x2检验.采用多因素回归分析各型肿瘤消退模式和患者发病年龄、患者性别、肿瘤大小、肿瘤部位、是否存在家族史的关系.结果 47只眼参照眼内型视网膜母细胞瘤国际分期分为A期20只眼(42.6％),B期13只眼(27.6％),C期6只眼(12.8％),D期8只眼(17.0％).122个瘤体平均每只眼瘤体数为2.6个.消退模式为0型3个,1型15个,2型8个,3型25个,4型71个.肿瘤厚度和肿瘤位置与肿瘤消退模式相关(x2 =86.52,21.15;P=0.000,0.007),初始肿瘤厚度＜2 mm的瘤体常见4型消退模式,厚度＞8 mm瘤体常见1型和3型消退模式.远离黄斑区的瘤体多见4型消退模式.多因素同归分析显示1型消退模式的预测因素为肿瘤厚度＞8 mm(Z =3.02·P =0.003).3型消退模式的预测因素为发病年龄大、肿瘤厚度＞8 mm和非赤道部-锯齿缘肿瘤(Z=3.98,2.23,3.60;P=0.000,0.025,0.000).4型消退模式的预测因素为存在家族史的患儿、肿瘤厚度＜2 mm及赤道部,锯齿缘的肿瘤(Z =4.37,3.42,2.42；P =0.000,0.000,0.021).12个瘤体复发,其中9个为3型消退模式,3个为4型消退模式.8只眼产生15个新瘤体.5例发生新肿瘤的患者均为发病年龄小和有家族史的患者.复发和产生新瘤体的时间平均为化疗结束后6个月.结论 化学减容加局部治疗后3型和4型消退模式最常见.小肿瘤常见4型消退模式,较大瘤体常见l型和3型消退模式.3型和4型消退模式肿瘤可能易复发.发病年龄小和有家族史的患者较易发生新肿瘤.接受化学减容加局部治疗的患者应进行密切随访.
目的 探討視網膜母細胞瘤(RB)化學減容加跼部治療後的臨床消退模式及預後.方法 迴顧性繫列病例研究.分析2005年1月至2009年6月間于複旦大學附屬眼耳鼻喉科醫院接受化學減容加跼部治療的RB患兒37例47隻眼,122箇RB瘤體.其中男性27例,女性10例.平均年齡為22箇月.化學減容加跼部治療以長春新堿、依託泊甙、卡鉑聯閤應用方案化學減容,輔以冷凍、經瞳孔溫熱療法等跼部鞏固治療.隨訪時間為12～60箇月,平均32箇月.視網膜母細胞瘤的消退模式包括0型:完全消退無痕跡；1型:完全鈣化；2型:無鈣化；3型:部分鈣化；4型:萎縮瘢痕.對于存在傢族史與否的患兒每隻眼瘤體數的統計學差異採用秩和檢驗,對于不同腫瘤厚度及腫瘤位置腫瘤消退模式的差異採用x2檢驗.採用多因素迴歸分析各型腫瘤消退模式和患者髮病年齡、患者性彆、腫瘤大小、腫瘤部位、是否存在傢族史的關繫.結果 47隻眼參照眼內型視網膜母細胞瘤國際分期分為A期20隻眼(42.6％),B期13隻眼(27.6％),C期6隻眼(12.8％),D期8隻眼(17.0％).122箇瘤體平均每隻眼瘤體數為2.6箇.消退模式為0型3箇,1型15箇,2型8箇,3型25箇,4型71箇.腫瘤厚度和腫瘤位置與腫瘤消退模式相關(x2 =86.52,21.15;P=0.000,0.007),初始腫瘤厚度＜2 mm的瘤體常見4型消退模式,厚度＞8 mm瘤體常見1型和3型消退模式.遠離黃斑區的瘤體多見4型消退模式.多因素同歸分析顯示1型消退模式的預測因素為腫瘤厚度＞8 mm(Z =3.02·P =0.003).3型消退模式的預測因素為髮病年齡大、腫瘤厚度＞8 mm和非赤道部-鋸齒緣腫瘤(Z=3.98,2.23,3.60;P=0.000,0.025,0.000).4型消退模式的預測因素為存在傢族史的患兒、腫瘤厚度＜2 mm及赤道部,鋸齒緣的腫瘤(Z =4.37,3.42,2.42；P =0.000,0.000,0.021).12箇瘤體複髮,其中9箇為3型消退模式,3箇為4型消退模式.8隻眼產生15箇新瘤體.5例髮生新腫瘤的患者均為髮病年齡小和有傢族史的患者.複髮和產生新瘤體的時間平均為化療結束後6箇月.結論 化學減容加跼部治療後3型和4型消退模式最常見.小腫瘤常見4型消退模式,較大瘤體常見l型和3型消退模式.3型和4型消退模式腫瘤可能易複髮.髮病年齡小和有傢族史的患者較易髮生新腫瘤.接受化學減容加跼部治療的患者應進行密切隨訪.
목적 탐토시망막모세포류(RB)화학감용가국부치료후적림상소퇴모식급예후.방법 회고성계렬병례연구.분석2005년1월지2009년6월간우복단대학부속안이비후과의원접수화학감용가국부치료적RB환인37례47지안,122개RB류체.기중남성27례,녀성10례.평균년령위22개월.화학감용가국부치료이장춘신감、의탁박대、잡박연합응용방안화학감용,보이냉동、경동공온열요법등국부공고치료.수방시간위12～60개월,평균32개월.시망막모세포류적소퇴모식포괄0형:완전소퇴무흔적；1형:완전개화；2형:무개화；3형:부분개화；4형:위축반흔.대우존재가족사여부적환인매지안류체수적통계학차이채용질화검험,대우불동종류후도급종류위치종류소퇴모식적차이채용x2검험.채용다인소회귀분석각형종류소퇴모식화환자발병년령、환자성별、종류대소、종류부위、시부존재가족사적관계.결과 47지안삼조안내형시망막모세포류국제분기분위A기20지안(42.6％),B기13지안(27.6％),C기6지안(12.8％),D기8지안(17.0％).122개류체평균매지안류체수위2.6개.소퇴모식위0형3개,1형15개,2형8개,3형25개,4형71개.종류후도화종류위치여종류소퇴모식상관(x2 =86.52,21.15;P=0.000,0.007),초시종류후도＜2 mm적류체상견4형소퇴모식,후도＞8 mm류체상견1형화3형소퇴모식.원리황반구적류체다견4형소퇴모식.다인소동귀분석현시1형소퇴모식적예측인소위종류후도＞8 mm(Z =3.02·P =0.003).3형소퇴모식적예측인소위발병년령대、종류후도＞8 mm화비적도부-거치연종류(Z=3.98,2.23,3.60;P=0.000,0.025,0.000).4형소퇴모식적예측인소위존재가족사적환인、종류후도＜2 mm급적도부,거치연적종류(Z =4.37,3.42,2.42；P =0.000,0.000,0.021).12개류체복발,기중9개위3형소퇴모식,3개위4형소퇴모식.8지안산생15개신류체.5례발생신종류적환자균위발병년령소화유가족사적환자.복발화산생신류체적시간평균위화료결속후6개월.결론 화학감용가국부치료후3형화4형소퇴모식최상견.소종류상견4형소퇴모식,교대류체상견l형화3형소퇴모식.3형화4형소퇴모식종류가능역복발.발병년령소화유가족사적환자교역발생신종류.접수화학감용가국부치료적환자응진행밀절수방.
Objective To evaluate retinoblastoma regression patterns following chemoreduction and adjuvant therapy.Methods Retrospective case series.122 tumors of 47 eyes of 37 patients following chemoreduction and adjuvant therapy between January 2005 and June 2009 in the Eye & ENT hospital of Fudan University.Twenty-seven patients are male,and 10 Patients are female. The average age was 22 months.The combined therapy included chemoreduction using vincristine,etoposide,and carboplatin ( VEC ) combined with local cryotherapy and/or transpupillary thermotherapy (TTT).The average follow-up duration was 32 months ranging from 12 to 60 months.Regression patterns included type 0 ( no remnant),type 1 (calcified remnant),type 2 (noncalcified remnant),type 3 (partially calcified remnant),and type 4 ( flat scar).Wilcoxon rank sum test was used to test the difference of tumor number between the patients with family history and those without family history.Chi-square test was used to test the difference between the tumor thickness,tumor location and regression patterns.Multivariate logistic regression analysis was used to test the correlation between the regression patterns and age,sex,tumor thickness,tumor location and family history.Statistical significance was assigned at P ＜ 0.05.Results Forty-seven eyes according to the International Intraocular Retinoblastoma Classification,20 eyes (42.6％ ) were group A,13 eyes (27.6％)group B,6 eyes ( 12.8％ ) group C,8 eyes ( 17.0％ ) group D.Of 122 tumors,the average number of tumors per eye was 2.6.Retinoblastoma regressions were type 0 ( n =3 ),type 1 ( n-15 ),type 2 ( n =8),type 3 (n =25),and type 4 (n =71 ).Tumor thickness and tumor location were related to regression patterns.Tumors with an initial thickness of 2 mm or less regressed most often to type 4,and those thicker than 8 mm regressed to type 1 or type 3.Tumors with greater distance from the foveola regressed most often to type 4.The factors predictive of regression pattern type 1 included tumor thickness larger than 8 mm ( Z =3.02,P =0.003 ).The factors predictive of regression pattern tvpe 3 included older age,tumor thickness larger than 8 mm and location not in the equator to ors serrata region( Z =3.98,2.23,3.60;P =0.000,0.025,0.000 ).The factors predictive of regression pattern type 4 included familial hereditary pattern,tumor thickness smaller than 2 mm and location in the equator to ors serrata region.(Z =4.37,3.42,2.42 ; P =0.000,0.000,0.021 ).12 tumors recurred,9 tumors were type 3 and 3 tumors were type 4.8 eyes developed 15 new tumors.5 patients developed new tumors were all younger patients and had familial hereditary history.The average period of recurrence of main tumors and development of new tumors was six months after the end of chemoreduction. Conclusiots Following chemoreduction,type 3 and type 4 regression patterns were most common.Smaller tumors were usually seen in type 4,and bigger tumors were usually seen in type 1 or type 3.Tumor recurrence was usually found following regression pattern type 3 or type 4.Younger patients and patients with familial hereditary history trended to develop new tumors.Patients accept chemoreduction and adjuvant therapy need close follow-up.
