Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments.
Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatments.
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DOI：
10.1002/pbc.21845
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发表时间：
2009-03
影响因子：
3.2
通讯作者：
Rodriguez-Galindo C
中科院分区：
文献类型：
--
作者：
Balaguer J;Wilson MW;Billups CA;Mancini J;Haik BG;Qaddoumi I;Khoury JD;Rodriguez-Galindo C
化疗、局部治疗、放射治疗和并存的眼部疾病对化疗后视网膜母细胞瘤摘除的眼组织学的影响尚不清楚。对23例(25眼)视网膜母细胞瘤保眼治疗失败后摘除的病例进行评价。眼球摘除的原因(肿瘤进展、视网膜下或玻璃体种子)和合并疾病(新生血管性青光眼、白内障、玻璃体出血和视网膜脱离)被记录在案。对所有标本进行复习，以寻找睫状体、脉络膜、视神经和巩膜侵犯的证据。确诊时的中位年龄为14个月(1至37个月)。20只眼诊断为Reese-Ellsworth IV-V组。24只眼在眼球摘除时复发；1只眼因新生血管性青光眼和玻璃体出血而被摘除。眼部并发症包括玻璃体出血6例，视网膜脱离9例，新生血管性青光眼9例，白内障3例。组织学表现：脉络膜侵犯7例，睫状体侵犯4例，视神经侵犯6例，巩膜侵犯3例。从诊断到摘除的中位时间为11个月。在摘除眼球前不进行任何治疗会显著增加侵袭的可能性。然而，合并视网膜脱离和玻璃体出血显著增加视神经侵犯的可能性(分别为p=0.014和p=0.011)。眼球摘除时间的延长与脉络膜(p=0.010)和睫状体(p=0.021)侵犯的可能性以及多部位侵犯显著相关。在化疗后视网膜母细胞瘤摘除的眼睛中，眼部并存的发病率和摘除眼球的时间预示着视网膜外的扩展。
The impact of chemotherapy, focal therapies, radiation and co-existing ocular morbidities on histology of eyes with retinoblastoma enucleated following chemoreduction is not well known. 25 eyes (23 patients) with retinoblastoma enucleated after failing eye-salvage therapy were evaluated. Reasons for enucleation (tumor progression, subretinal or vitreous seeds) and co-morbid conditions (neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment) were documented. All specimens were reviewed for evidence of ciliary body, choroidal, optic nerve, and scleral invasion. The median age at diagnosis was 14 months (range, 1 to 37 months). Twenty eyes were classified as Reese-Ellsworth Group IV-V at diagnosis. Twenty-four eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and vitreous hemorrhage. Co-existing ocular morbidities at enucleation included vitreous hemorrhage (n=6), retinal detachment (n=9), neovascular glaucoma (n=9) and cataracts (n=3). Histologic findings included choroidal invasion (n=7), ciliary body invasion (n=4), optic nerve invasion (n=6) and scleral invasion (n=3). The median time from diagnosis to enucleation was 11 months. No treatment rendered prior to enucleation significantly increased the likelihood of invasion. However, co-existing retinal detachment and vitreous hemorrhage significantly increased the likelihood of optic nerve invasion (p=0.014 and p=0.011, respectively). Prolonged time to enucleation was significantly associated with the likelihood of choroidal (p=0.010) and ciliary body (p=0.021) invasion as well as invasion of multiple sites. In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and time to enucleation are predictive of extra-retinal extension.