The Predictive Value of the Eighth Edition of the Clinical TNM Staging System for the Likelihood of Eye Salvage for Intraocular Retinoblastoma by Systemic Chemotherapy and Focal Therapy.
The Predictive Value of the Eighth Edition of the Clinical TNM Staging System for the Likelihood of Eye Salvage for Intraocular Retinoblastoma by Systemic Chemotherapy and Focal Therapy.
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DOI：
10.1097/mph.0000000000002144
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发表时间：
2021-08-01
期刊：
影响因子：
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通讯作者：
Al-Nawaiseh I
中科院分区：
文献类型：
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作者：
Yousef YA;Mohammad M;Mehyar M;Sultan I;Al-Hussaini M;Alhourani J;Halalsheh H;Khzouz J;Jaradat I;Qaddoumi I;Al-Nawaiseh I
AJCC/UICC cTNM 分期正在成为所有癌症（包括视网膜母细胞瘤 (RB)）的通用分期。在这里，我们使用 Logistic 回归模型评估了第八版 AJCC/UICC cTNM 分期与国际眼内视网膜母细胞瘤分类 (IIRC) 的比较，对于通过初次全身化疗和局部治疗 (CRD) 挽救眼球的治疗失败概率的预测价值。 565只接受治疗的眼睛中，T1肿瘤的挽救率为95%（n=139/147）（T1a为98%，T1b为93%），T2肿瘤为56%（n=230/410）（T2a为81%，T2b为53%），T3肿瘤为0%，分别为98%、93%、76%， A、B、C 和 D 组肿瘤分别为 44%。根据比值比估计，T2 治疗失败的可能性是 T1 的 13.6 倍，T1b、T2a 和 T2b 治疗失败的可能性分别是 T1a 的 2.8、9.4 和 35.1 倍。 B、C 和 D 组肿瘤治疗失败的可能性分别是 A 组肿瘤的 2.8、12.7 和 50.1 倍。对于具有局灶性种子（距离肿瘤边缘 3 毫米）的眼睛，眼睛挽救率为 62％，对于具有弥漫性种子（距离肿瘤边缘超过 3 毫米的云）的眼睛，眼睛挽救率为 42％（P<.0001）。第八版 cTNM 分类和 IIRC 系统都可以通过 CRD 有效预测 RB 的眼挽救率。 cT 阶段较高的眼睛更有可能经历治疗失败。由于 cT2b 组非常异质，我们的研究结果建议根据玻璃体/视网膜下种子的严重程度进一步划分该组，这应该在下一版 cTNM 系统中进行修订。
The AJCC/UICC cTNM staging is emerging as a universal staging for all cancers, including retinoblastoma (RB). Here we evaluated the predictive value of the eighth edition AJCC/UICC cTNM staging in comparison with the International Intraocular Retinoblastoma Classification(IIRC)for eye globe salvage by primary systemic chemotherapy and focal therapy(CRD) using logistic regression model for the probability of treatment failure. The eye salvage rate for 565 treated eyes was 95%(n=139/147) for T1 tumors (98% for T1a and 93% for T1b), 56%(n=230/410) forT2(81%for T2a and 53% for T2b), and 0%for T3 tumors, and was 98%,93%,76%, and 44% for group A,B,C, and D tumors respectively. As estimated by odds ratios, T2 were 13.6-fold more likely to fail treatment than T1, and T1b,T2a, and T2b were 2.8-, 9.4-, and 35.1-fold more likely to fail treatment than T1a, respectively. Group B,C, and D tumors were 2.8-,12.7-, and 50.1-fold more likely to fail treatment than group A tumors, respectively. Eye salvage rate was 62% for eyes with focal seeds (3-mm close to the tumor), and 42% for eyes with diffuse seeds (clouds more than 3-mm from tumor edge) (P<.0001). Both, the eighth edition cTNM classification and the IIRC systems, can effectively predict eye salvage rates for RB by CRD. Eyes with higher cT stages are more likely to experience treatment failure. Because the cT2b group is very heterogeneous, our findings suggest further division of this group based on the severity of vitreous/subretinal seeds, this should be revised in the next edition of cTNM system.