附加化疗在视网母细胞瘤与后层光神经入侵后的辅助化疗:全球多中心研究
Michelle Lin1, Sarah B Pike1, Mark W Reid2
1The Vision Center, Children's Hospital Los Angeles, Los Angeles, CA, United States; USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
Ophthalmology. Retina
|December 31, 2025
概括
辅助化疗显著减少复发,转移和死亡的视网膜母细胞瘤 (RB) 患者的后层视神经入侵 (PLONI). 即使是单独的PLONI,化疗也会随着时间的推移降低转移风险.
科学领域:
- 眼科医生 眼科 眼科
- 儿科瘤学 儿科瘤学
- 癌症研究 癌症研究
背景情况:
- 视网母细胞瘤 (RB) 是儿童最常见的初级眼内恶性瘤.
- 膜后视神经侵袭 (PLONI) 是RB中不良结果的重要风险因素.
- 初级核切除是标准治疗方法,但对于高风险病例,通常会考虑辅助疗法.
研究的目的:
- 为了评估辅助化疗对RB患者的结局的影响,在初级核化后具有PLONI的基因病学证据.
- 为了比较接受辅助化疗和未接受辅助化疗的患者之间的复发,转移和死亡率.
主要方法:
- 多中心回顾性队列研究,涉及9个国家的292名RB和PLONI患者.
- 对接受辅助化疗 (n=276) 和不接受辅助化疗 (n=16) 的患者结局的比较.
- 统计分析包括费舍尔的精确测试,韦尔奇的t测试和比例危险模型 (Cox和竞争性风险). 进行了组合PLONI与大规模胆膜入侵和分离PLONI的子分析.
主要成果:
- 不接受辅助化疗的患者有明显更高的轨道瘤复发率 (31%对2%),转移率 (31%对6%) 和死亡率 (38%对9%).
- 在没有接受化疗的患者中,事件发生的时间分析显示,复发 (SHR=19.31),转移 (SHR=5.39) 和死亡 (HR=4.74) 的风险大大增加.
- 随着时间的推移,辅助化疗显著降低了转移风险,即使是在单独的PLONI患者中 (转移SHR=40.68).
结论:
- 在初级核切除后的辅助化疗通过减少PLONI和其他高风险特征的RB患者的复发,转移和死亡,显著改善了结果.
- 虽然单独的PLONI携带的风险低于组合的高风险特征,但辅助化疗在减轻转移风险方面仍然有益.
- 在这项研究中,所有经历转移或复发的患者最终都死亡,这强调了对有效辅助治疗的急需.
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