Ophthalmology:视网膜母细胞瘤患者的转移性死亡率

2022-05-06 Nebula MedSci原创

视网膜母细胞瘤患者的转移性死亡风险随着cT分型的增加而升高

癌症分期系统是确定肿瘤范围、制定治疗策略和评估预后的重要工具。目前对晚期眼内视网膜母细胞瘤 (RB) 采取保守治疗的趋势日益明显。因此,视网膜母细胞瘤的分期系统应该(尽可能精确地)预测不同患者接受不同治疗的预后。

既往研究显示,全球最常见的视网膜母细胞瘤类型是AJCC cT3期,在诊断时对cT3期RB临床特征进行进一步的分层或可更准确地预测患者转移性疾病的风险。本研究旨在基于临床特征、眼内肿瘤大小和治疗方式来评估RB患者转移性疾病相关死亡的风险。

纳入了于2001年至2013年登记的1841位晚期RB患者。晚期RB的定义:第八版AJCC cT2和cT3期以及新AJCC-OOTF Size组(1组:<全眼体积的50%;2组:>50%且<2/3;3组:>2/3;4组:弥漫性浸润性视网膜成细胞瘤)。治疗方式有眼球摘除术、全身化疗+二次剜除术和全身化疗+眼球挽救治疗。主要评估指标是转移性死亡。


根据AJCC分期分组的生存率

AJCC临床分类不同的患者的5年Kaplan-Meier累积生存率如下:cT2a期,98%;cT2b, 96%;cT3a, 96%;cT3b, 95%;cT3c, 92% ;cT3d,84%;cT3e期,75%。 采用眼球摘除术、全身化疗+二次剜除术或全身化疗+眼球挽救治疗的生存率分别是96%、89%和90%。


不同治疗组患者的生存率

转移性疾病死亡风险随着cT分型的增加而升高 (p<0.001)。与cT2a期患者相比,cT3c期(风险比[HR] 4.9,p=0.011)、cT3d(14.0,p<0.001)和cT3e期(19.6,p<0.001)患者的转移性疾病死亡风险更高;与眼球摘除术相比,采用全身化疗+二次剜除(HR 3.3,p<0.001)和化疗+眼球挽救(4.9,p<0.001)治疗的患者的转移性疾病死亡风险也更高。


根据OOTF Size分组患者的生存率

 

AJCC-OOTF Size 1-4组的5年Kaplan-Meier累积生存率分别为99%、96%、94%和83%。转移性RB的死亡率随肿瘤大小分组的增加而升高(p<0.001)。与Size 1组相比,Size 3组(HR 10.0, p=0.002)和4组(41.1,p<0.001)患者的转移相关死亡风险均更高。

综上,AJCC-RB cT2和cT3分型和基于肿瘤大小划分的AJCC-OOTF Size组有助于将晚期眼内视网膜母细胞瘤患者发生转移性死亡的临床风险进一步分层,为临床治疗和研究提供了极具预后价值的工具。值得注意的是,采用眼球摘除治疗的晚期RB患者的生存率最高。

 

原始出处:

Tomar Ankit Singh,Finger Paul T,Gallie Brenda et al. Metastatic Death Based on Presenting Features and Treatment for Advanced Intraocular Retinoblastoma: A Multicenter Registry-based Study.[J] .Ophthalmology, 2022, https://doi.org/10.1016/j.ophtha.2022.04.022

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    2022-05-11 ms8000001725144884

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    2022-05-06 zutt
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