Brennan Rachel C, Qaddoumi Ibrahim, Billups Catherine A, Free Tammy L, Haik Barrett G, Rodriguez-Galindo Carlos, Wilson Matthew W
Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee, USA Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Br J Ophthalmol. 2015 Oct;99(10):1366-71. doi: 10.1136/bjophthalmol-2014-306364. Epub 2015 Apr 14.
To compare high-risk histopathology of eyes with primary versus secondary enucleation from patients with retinoblastoma.
A retrospective histopathology review identified 207 eyes enucleated from 202 patients between March 1997 and August 2013. Our review considered high-risk histopathological features to include extraocular disease or invasion of the anterior chamber, iris, ciliary body, choroid (massive), postlaminar optic nerve or sclera.
Most eyes (144, 70%) were primarily enucleated; 63 (30%) were secondarily enucleated after neoadjuvant therapy. The primary enucleation group had more advanced disease (Reese-Ellsworth group V: 95% vs 59%; International Classification Group D/E: 97% vs 59%; p<0.001). The incidence of high-risk histopathology features was similar between groups (32% vs 21%, n=59; p=0.132). The type of prior therapy was not associated with high-risk histopathology features. Time to enucleation was longer for secondarily enucleated eyes with high-risk features. Choroid and postlaminar optic nerve invasion were more frequent in eyes primarily enucleated (p<0.001). Forty-six of the 59 (78%) patients with high-risk features received adjuvant chemotherapy and/or external beam radiation therapy. Three patients who received primary enucleation and adjuvant therapy died of metastatic recurrence.
Despite the more favourable classification of eyes treated with neoadjuvant therapy, the risk of high-risk histopathology features at enucleation was comparable with eyes undergoing primary enucleation. Delayed enucleation was associated with these features, and the majority of patients required further adjuvant therapy. Caution must be exercised in treating recalcitrant intraocular retinoblastoma to promptly pursue definitive enucleation in an effort to minimise further treatment exposures and metastases.
比较视网膜母细胞瘤患者行一期眼球摘除术与二期眼球摘除术时眼睛的高危组织病理学特征。
通过回顾性组织病理学分析，确定了1997年3月至2013年8月期间202例患者摘除的207只眼球。本研究将高危组织病理学特征定义为包括眼外疾病或前房、虹膜、睫状体、脉络膜（大量）、视神经筛板后段或巩膜受侵。
大多数眼球（144只，70%）接受一期眼球摘除术；63只（30%）在新辅助治疗后接受二期眼球摘除术。一期眼球摘除术组疾病分期更晚（里斯-埃尔斯沃思分期Ⅴ期：95%对59%；国际分期D/E组：97%对59%；p<0.001）。两组高危组织病理学特征的发生率相似（32%对21%，n = 59；p = 0.132）。既往治疗类型与高危组织病理学特征无关。具有高危特征的二期摘除眼球的摘除时间更长。一期摘除的眼球中脉络膜和视神经筛板后段受侵更常见（p<0.001）。59例（78%）具有高危特征的患者接受了辅助化疗和/或外照射放疗。3例行一期眼球摘除术并接受辅助治疗的患者死于转移性复发。
尽管新辅助治疗的眼球分类更有利，但摘除时高危组织病理学特征的风险与一期眼球摘除术的眼球相当。延迟摘除与这些特征相关，大多数患者需要进一步的辅助治疗。在治疗难治性眼内视网膜母细胞瘤时必须谨慎，应及时进行确定性眼球摘除术，以尽量减少进一步的治疗暴露和转移。
