Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom.
Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom; Department of Ophthalmology, University of Washington, Seattle, Washington.
Ophthalmology. 2017 Jun;124(6):851-858. doi: 10.1016/j.ophtha.2017.01.048. Epub 2017 Mar 13.
To evaluate the rate and identify the risk factors for high-risk histopathologic features in group D retinoblastoma eyes enucleated as primary or secondary treatment.
Retrospective analysis.
A total of 64 enucleated group D eyes (62 patients), of which 40 (40 patients) were primary and 24 (22 patients) were secondary to other treatments.
Clinicopathologic correlation of consecutive group D eyes enucleated from 2002 to 2014. High-risk histopathologic features were defined as the presence of anterior chamber seeds, iris infiltration, ciliary body/muscle infiltration, massive (≥3 mm) choroidal invasion, retrolaminar optic nerve invasion, or combined non-massive choroidal and prelaminar/laminar optic nerve invasion.
High-risk histopathologic features, metastasis, and death.
Of the 64 group D eyes, 37 (58%) were classified as cT2bN0M0H0, 24 (38%) were classified as cT2bN0M0H1, and 3 (5%) were classified as cT2aN0M0H1, according to the 8th edition cTNMH Retinoblastoma Staging. High-risk histopathologic features were detected in 10 eyes (16%) in the entire cohort, 5 eyes (13%) of the primary enucleated group (pT3aNxM0, n = 2 and pT3bNxM0, n = 3, 8th edition pTNM), and 5 eyes (21%) of the secondary enucleated group (pT2bNxM0, n = 2, pT3aNxM0, n = 2 and pT3cNxM0, n = 1). Absence of vitreous seeds at presentation was the only predictive factor found for high-risk histopathologic features in the primary enucleation group (P = 0.042), whereas none were found in the secondary group (P ≥ 0.179). Invasion of the anterior structures (anterior chamber, iris, ciliary body/muscle) was detected significantly more after secondary enucleation (P = 0.048). All patients with high-risk histopathologic features were treated with adjuvant chemotherapy, and no metastases were recorded in a median follow-up time of 73.2 months (mean, 71.5; range, 13.7-153.0).
The choice of primary treatment for group D retinoblastoma should be carefully weighed, because according to this study, 13% of eyes harbor high-risk histopathologic features at presentation, with the absence of vitreous seeds being a potential risk factor. It is of special importance in group D eyes being considered for nonsystemic treatment, such as primary intraophthalmic artery chemotherapy. Secondary enucleated group D eyes with high-risk histopathologic features more commonly involved anterior structures, warranting meticulous clinical and histologic examinations for this subset of patients.
评估作为原发性或继发性治疗而被摘除的 D 组视网膜母细胞瘤眼中出现高危组织病理学特征的发生率并识别其危险因素。
回顾性分析。
共纳入 64 只接受 D 组眼（62 例患者）摘除的眼球，其中 40 只为原发性（40 例患者），24 只为其他治疗的继发性（22 例患者）。
对 2002 年至 2014 年间连续摘除的 D 组眼进行临床病理相关性分析。高危组织病理学特征定义为前房种子、虹膜浸润、睫状体/肌肉浸润、大量（≥3mm）脉络膜侵犯、视盘后神经侵犯，或联合非大量脉络膜和视盘前/视盘神经侵犯。
高危组织病理学特征、转移和死亡。
根据第 8 版 cTNMH 视网膜母细胞瘤分期，64 只 D 组眼中，37 只（58%）为 cT2bN0M0H0，24 只（38%）为 cT2bN0M0H1，3 只（5%）为 cT2aN0M0H1。整个队列中，有 10 只眼（16%）检测到高危组织病理学特征，原发性摘除组有 5 只眼（13%）（第 8 版 pTNM 中 pT3aNxM0，n=2 和 pT3bNxM0，n=3），继发性摘除组有 5 只眼（21%）（pT2bNxM0，n=2，pT3aNxM0，n=2 和 pT3cNxM0，n=1）。原发性摘除组中，在初次就诊时不存在玻璃体种子是发现高危组织病理学特征的唯一预测因素（P=0.042），而在继发性摘除组中未发现任何预测因素（P≥0.179）。在继发性摘除后，前结构（前房、虹膜、睫状体/肌肉）的侵犯明显更常见（P=0.048）。所有患有高危组织病理学特征的患者均接受了辅助化疗，在中位随访时间为 73.2 个月（平均 71.5；范围 13.7-153.0）时，未记录到转移。
应仔细权衡 D 组视网膜母细胞瘤的原发性治疗选择，因为根据这项研究，在初次就诊时，有 13%的眼存在高危组织病理学特征，而玻璃体中不存在种子可能是一个潜在的危险因素。对于考虑进行非系统性治疗（如原发性眼内动脉化疗）的 D 组眼来说，这一点尤为重要。在接受继发性摘除的 D 组眼中，高危组织病理学特征更常见于前结构，这就需要对这些患者进行仔细的临床和组织学检查。
