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中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (02) : 70 -75. doi: 10.3877/cma.j.issn.2095-2007.2021.02.002

论著

经眼动脉与经静脉化学疗法治疗单眼D期视网膜母细胞瘤的临床研究
张诚玥1, 金眉2, 阴捷3, 吴荣昌3, 刘冬悦4, 韩立坡4, 王争4, 王凤仙4, 张楠5, 赵军阳6, 李莉6,†()   
  1. 1. 100045　首都医科大学附属北京儿童医院眼科　国家儿童医学中心；071000　保定市儿童医院眼科
    2. 100045　首都医科大学附属北京儿童医院血液肿瘤中心　儿童血液病与肿瘤分子分型北京市重点实验室
    3. 100045　首都医科大学附属北京儿童医院影像中心
    4. 071000　保定市儿童医院眼科
    5. 100045　首都医科大学附属北京儿童医院病理科
    6. 100045　首都医科大学附属北京儿童医院眼科　国家儿童医学中心
  • 收稿日期:2021-03-09 出版日期:2021-04-28
  • 通信作者: 李莉
  • 基金资助:
    国家卫生健康委员会卫生行业科研专项项目(2014040)

The effect of intravenous chemotherapy and intra-arterial chemotherapy for unilateral group D retinoblastoma

Chengyue Zhang1, Mei Jin2, Jie Yin3, Rongchang Wu3, Dongyue Liu4, Lipo Han4, Zheng Wang4, Fengxian Wang4, Nan Zhang5, Junyang Zhao6, Li Li6,†()   

  1. 1. Department of Ophthalmology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China; Baoding Children′s Hospital, Baoding 071000, China
    2. Department of Hematology Oncology Center, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
    3. Department of Radiology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing, China
    4. Baoding Children′s Hospital, Baoding 071000, China
    5. Department of Pathology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
    6. Department of Ophthalmology, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
  • Received:2021-03-09 Published:2021-04-28
  • Corresponding author: Li Li
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引用本文：

张诚玥, 金眉, 阴捷, 吴荣昌, 刘冬悦, 韩立坡, 王争, 王凤仙, 张楠, 赵军阳, 李莉. 经眼动脉与经静脉化学疗法治疗单眼D期视网膜母细胞瘤的临床研究[J]. 中华眼科医学杂志(电子版), 2021, 11(02): 70-75.

Chengyue Zhang, Mei Jin, Jie Yin, Rongchang Wu, Dongyue Liu, Lipo Han, Zheng Wang, Fengxian Wang, Nan Zhang, Junyang Zhao, Li Li. The effect of intravenous chemotherapy and intra-arterial chemotherapy for unilateral group D retinoblastoma[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(02): 70-75.

目的

比较经眼动脉灌注化学治疗(IAC)和经静脉全身化学治疗(IVC)对眼内D期视网膜母细胞瘤(RB)的临床疗效及其并发症。

方法

纳入自2018年12月至2021年1月在首都医科大学附属北京儿童医院眼科收治的60例(60只眼)单眼D期RB患者作为研究对象。其中，男性32例(32只眼)，女性28例(28只眼)。患者年龄为10个月至40个月，平均年龄(24.5±7.3)个月。根据患者接受治疗方法的不同，分为IAC治疗组和IVC治疗组。前者30例(30只眼)患者接受了经眼动脉灌注化学治疗；后者30例(30只眼)接受了经静脉全身化学治疗。记录两组患者经过不同治疗后眼球是否保留、肿瘤控制情况、治疗时间、随访时间和是否出现治疗相关的并发症等，并计算两组患者的保眼率、实体肿瘤控制率、视网膜下肿瘤种植控制率及玻璃体肿瘤种植控制率。患者的保眼率、实体肿瘤控制率、视网膜下肿瘤种植控制率及玻璃体肿瘤种植控制率以眼数和百分率表示，组间比较采用卡方检验。治疗时间和随访时间符合正态分布以±s表示，组间比较采用两独立样本t检验。

结果

IAC治疗组和IVC治疗组患者的保眼率分别为86.7%(26/30)和46.7%(14/30)，差异有统计学意义(χ2＝10.800，P<0.05)。IAC治疗组和IVC治疗组患者的实体肿瘤控制率分别为80%(24/30)和43.3%(13/30)，差异有统计学意义(χ2＝8.531，P<0.05)。IAC治疗组和IVC治疗组患者的视网膜下肿瘤种植控制率分别为78.9%(15/19)和38.9%(7/18)，差异有统计学意义(χ2＝6.153，P<0.05)。IAC治疗组和IVC治疗组患者的玻璃体肿瘤种植控制率分别为71.4%(15/21)和36.8% (7/19)，差异有统计学意义(χ2＝4.821，P<0.05)。IAC治疗组和IVC治疗组患者的治疗时间分别为(3.30±1.48)个月和(5.85±1.62)个月，差异有统计学意义(t＝5.197，P<0.05)。IAC治疗组患者出现更少的全身并发症和较轻的眼部及眼周并发症。且两组均无患儿出现死亡或者肿瘤眼外转移。在IAC治疗组中，有4只眼最终行眼球摘除手术，术后病理显示不存在病理高危因素。在IVC治疗组中，有16只眼最终行眼球摘除手术，术后病理显示有8只眼存在病理高危因素。

结论

IAC疗法在治疗单眼D期RB方面具有肿瘤控制率高、保眼率高、治疗并发症少且轻等优势。

关键词: 经静脉全身化疗, 经眼动脉灌注化疗, 视网膜母细胞瘤, 儿童
Objective

The aim fo this study was to explore the clinical efficacy and complications of intravenous chemotherapy and intra-arterial chemotherapy for unilateral group D retinoblastoma.

Methods

60 patients (60 eyes) unilateral group D retinoblastoma patients diagnosed at Beijing Children′s Hospital affiliated to Capital Medical University from December 2018 to January 2021 were enrolled. Among of them, 32 cases (32 eyes) were male and 28 cases (28 eyes) were female, with mean age of (24.5±7.3) months (ranging from 10 to 40 months). All patients were assigned to two groups according to treatment modalities. The number of patients received intra-arterial chemotherapy (IAC), and intravenous chemotherapy (IVC) was half-half. Globe salvage, tumor control, treatment time, follow-up time and complications after different treatment modalities were recorded. Globe salvage rate, solid tumor control, subretinal seeds control, vitreous seeds control were computed. Globe salvage rate, solid tumor control, subretinal seeds control and vitreous seeds control were expressed with percentage, which was compared by Chi-square test. Treatment time was expressed by ±s , which was compared by two independent samples t-test.

Results

The globe salvage rate of IAC group and IVC group were 86.7%(26/30) and 46.7%(14/30), respectively. There was a statistically significant differentce between them (χ2=10.800, P<0.05). Solid tumor control of IAC group and IVC group were 80%(24/30) and 43.3%(13/30), respectively. The difference between two groups was statistically significant between them (χ2=8.531, P<0.05). Subretinal seeds control of IAC group and IVC group were 78.9%(15/19) and 38.9%(7/18), respectively. There was a statistically significant differentce between them (χ2=6.153, P<0.05). Vitreous seeds control of IAC group and IVC group were 71.4%(15/21) and 36.8%(7/19), respectively. The difference between two groups was statistically significant (χ2=4.821, P<0.05). Treatment time in IAC group and IVC group were (3.30±1.48) months and(5.85±1.62)months, respectively. The difference between two groups was statistically significant (t=5.197, P<0.05). There were less systemic complications, mild ocular and periocular side effects in IAC group. Moreover, there were no patients with metastasis or death in either group. In IAC group, 4 globes were removed. The pathological result showed there was no high risk factor in 4 enucleated eyeball. In IVC group, 16 globes were removed. The pathological result showed 8 enucleated eyeballs had high risk factors.

Conclusions

For unilateral group D retinoblastoma, IAC provided significantly superior tumor control, globe salvage, less and mild complications compared with IVC.

Key words: Intravenous chemotherapy, Intra-arterial chemotherapy, Retinoblastoma, Child
表1 两组患者基本情况的比较
分组 眼数(只) 年龄(±s，月) 性别 眼别 阳性家族史[眼数(%)]
男性[眼数(%)] 女性[眼数(%)] 右眼[眼数(%)] 左眼[眼数(%)]
IAC治疗组 30 24.85±4.38 14(46.7%) 16(53.3%) 17(56.7%) 13(43.3%) 2( 6.7%)
IVC治疗组 30 24.04±4.42 18(60.0%) 12(40.0%) 12(40.0%) 18(60.0%) 3(10.0%)
t/χ2值   0.582 1.071* 1.669* 0.218*
P值   >0.05 >0.05 >0.05 >0.05
表2 两组患者眼内肿瘤基本特征的比较
分组 眼数(只) 视网膜下种植[眼数(%)] 玻璃体种植[眼数(%)] 部分视网膜脱离[眼数(%)] 全视网膜脱离[眼数(%)]
IAC治疗组 30 19(63.3%) 21(70.0%) 16(53.3%) 14(46.7%)
IVC治疗组 30 18(60.0%) 19(63.3%) 19(63.3%) 11(36.7%)
χ2值   0.071 0.300 0.617  
P值   >0.05 >0.05 >0.05  
图3 眼摘术后具有肿瘤高危因素病理图像　图3A示肿瘤侵犯脉络膜范围>3 mm，黑色箭头为肿瘤侵润脉络膜位置(莱卡光学显微镜，HE染色×40)；图3B示肿瘤穿过筛板，黑色箭头为筛板位置(莱卡光学显微镜，HE染色×40)
表3 两组患者治疗结局和并发症的比较
分组 眼数(只) 治疗时间(±s，月) 联合视网膜激光或冷冻[眼数(%)] 保眼率[眼数(%)] 实体肿瘤控制率[眼数(%)] 视网膜下种植控制率[眼数(%)] 玻璃体种植控制率[眼数(%)]
IAC治疗组 30 3.30±1.48 12(40.0%) 26(86.7%) 24(80.0%) 15(78.9%) 15(71.4%)
IVC治疗组 30 5.85±1.62 21(70.0%) 14(46.7%) 13(43.3%) 7(38.9%) 7(36.8%)
t/χ2值   5.197 5.455* 10.800* 8.531* 6.153* 4.821*
P值   <0.05 <0.05 <0.05 <0.05 <0.05 <0.05
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