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目的 探讨视网膜母细胞瘤 (retinoblastoma,RB)细胞分化程度对扩散和存活预后的影响。 方法 对 15 6份 RB眼球标本进行组织病理学观察 ,根据肿瘤细胞分化程度将其分为分化型与未分化型 ,注意有无肿瘤细胞的扩散 ,并统计两型发生扩散的比率。对随访到的 82例 RB患者进行死亡率统计。用χ2 检验的方法比较两型间死亡率和扩散发生率。记录扩散部位与死亡率之间的关系、死者生前眼球摘除术后平均存活时间。 结果 分化型 RB17例 17只眼 ,发生肿瘤细胞局部扩散 8只眼 ,占 47.0 6 % ;未分化型 137例 139只眼 ,发生局部扩散 6 6只眼 ,占 47.48%。两型间发生扩散的比率差异无显著性意义 (P>0 .0 5 )。随访到的患者中 ,分化型 RB死亡率 2 7.2 7% ,未分化型 RB死亡率 2 2 .5 4% ,二者比较差异亦无显著性意义(P>0 .0 5 )。眶内和巩膜侵犯者死亡率 10 0 % ,视神经侵犯 级者死亡率 6 2 .5 0 % ,葡萄膜侵犯者死亡率2 2 .2 2 %。眼球摘除术后生存时间为 5～ 41个月 ,平均 2 1.92个月。 结论 分化型与未分化型 RB的存活预后及局部扩散比率差异无显著性意义。发生扩散的 RB,无论是分化型还是未分化型其预后均取决于扩散的程度以及是否进行积极治疗。
Objective To investigate the effect of retinoblastoma (RB) cell differentiation on the prognosis of proliferation and survival. Methods 15 6 RB eyeballs were observed histopathologically. According to the degree of differentiation of tumor cells, they were divided into differentiated and undifferentiated type. Attention was paid to the proliferation of tumor cells, and the ratio of two types of proliferation was calculated. The follow-up of 82 patients with RB mortality statistics. Chi-square test was used to compare mortality and spread between the two groups. Record the relationship between the site of proliferation and mortality, the average survival time of the deceased before enucleation. Results Differentiated RB17 cases of 17 eyes, the local spread of tumor cells in 8 eyes, accounting for 47.0%; 137 cases of undifferentiated 137 cases, the local proliferation of 66 eyes, accounting for 47.48%. There was no significant difference in the rate of diffusion between the two types (P> 0.05). Among the patients who were followed up, the death rate of differentiated RB was 2 7.27%, and the mortality of undifferentiated RB was 22.54%. There was no significant difference between the two groups (P> 0.05). Orbital and scleral invasion of the 10% mortality rate, optic nerve invasion grade death rate of 62.5%, uveal invasion of 22.22%. The survival time after enucleation was 5 to 41 months, an average of 2.192 months. Conclusion There is no significant difference in the survival prognosis and local spread between differentiated and undifferentiated RB. The spread of RB, whether it is differentiated or undifferentiated prognosis depends on the extent of proliferation and whether aggressive treatment.