J Pediatr Ophthalmol Strabismus. 2020 Jul 1;57(4):224-234. doi: 10.3928/01913913-20200417-01.
To identify risk factors for retinoblastoma recurrence following chemoreduction.
This was a retrospective review of patients with retinoblastoma treated from 1994 to 2019 using chemoreduction with analysis for recurrence using Kaplan-Meier, Cox regression, and logistic regression.
There were 869 eyes of 551 patients with retinoblastoma treated with chemoreduction. Follow-up in 556 eyes revealed main solid tumor recurrence (n = 355, 64%), subretinal seed recurrence (n = 244, 44%), vitreous seed recurrence (n = 162, 29%), and/or new tumor (n = 118, 21%) requiring management with focal therapy (transpupillary thermotherapy, cryotherapy) (n = 294, 53%), intra-arterial chemotherapy (n = 125, 22%), intravitreal chemotherapy (n = 36, 6%), plaque radiotherapy (n = 120, 22%), external beam radiotherapy (n = 57, 10%), and/or enucleation (n = 49, 9%). Of all recurrences, 62% were detected by 1 year, 86% by 2 years, 94% by 3 years, 98% by 5 years, 99% by 10 years, and 100% by 15 years. Risk factors for recurrence on multivariate analysis included younger patient age at presentation (odds ratio [OR] = 1.02 [1.00 to 1.04] per 1 month decrease, P = .02), greater International Classification of Retinoblastoma group (OR = 1.24 [1.05 to 1.47] per 1 more advanced group, P = .01), shorter tumor distance to optic disc (OR = 1.11 [1.01 to 1.21] per 1 mm decrease, P = .03), and presence of subretinal seeds (OR = 1.66 [1.09 to 2.53], P = .02).
Retinoblastoma recurrence after chemoreduction is usually detected within the first 3 years following treatment. Younger patients with more advanced, posteriorly located tumors and subretinal seeds at presentation are at increased risk, but recurrence can often be managed with globe-sparing therapy. [J Pediatr Ophthalmol Strabismus. 2020;57(4):224-234.].
确定化学减瘤术后视网膜母细胞瘤（RB）复发的危险因素。
这是一项回顾性研究，对 1994 年至 2019 年期间采用化学减瘤治疗的 RB 患者进行分析，采用 Kaplan-Meier 法、Cox 回归和逻辑回归分析复发情况。
共有 551 例患者的 869 只眼接受了化学减瘤治疗。对 556 只眼进行了随访，发现主要实性肿瘤复发（n=355，64%）、视网膜下种子复发（n=244，44%）、玻璃体种子复发（n=162，29%）和/或新肿瘤（n=118，21%）需要进行局部治疗（经瞳孔温热疗法、冷冻疗法）（n=294，53%）、动脉内化疗（n=125，22%）、玻璃体内化疗（n=36，6%）、敷贴放疗（n=120，22%）、外照射放疗（n=57，10%）和/或眼球摘除术（n=49，9%）。所有复发中，62%在 1 年内发现，86%在 2 年内发现，94%在 3 年内发现，98%在 5 年内发现，99%在 10 年内发现，100%在 15 年内发现。多变量分析的复发危险因素包括患者就诊时年龄较小（每减少 1 个月，比值比[OR]为 1.02[1.00 至 1.04]，P=0.02）、国际视网膜母细胞瘤分类（OR）较高（每增加一个更高级别的组，OR 为 1.24[1.05 至 1.47]，P=0.01）、肿瘤距视盘的距离较短（每减少 1 毫米，OR 为 1.11[1.01 至 1.21]，P=0.03）和存在视网膜下种子（OR 为 1.66[1.09 至 2.53]，P=0.02）。
化学减瘤术后 RB 复发通常在治疗后 3 年内发现。就诊时年龄较小、病变位置较后、肿瘤位置较后、视网膜下有种子的患者复发风险增加，但通常可以通过保眼球治疗来控制复发。
