High-Risk Histopathology Features in Primary and Secondary Enucleated International Intraocular Retinoblastoma Classification Group D Eyes

被引:33
作者
Fabian, Ido D. [1 ,2 ]
Stacey, Andrew W. [1 ,2 ,3 ]
Chowdhury, Tanzina [2 ,4 ]
Duncan, Catriona [2 ,4 ]
Karaa, Esin K. [5 ]
Scheimberg, Irene [5 ]
Reddy, M. Ashwin [2 ]
Sagoo, Mandeep S. [1 ,2 ,6 ,7 ]
机构
[1] Moorfields Eye Hosp, Ocular Oncol Serv, London, England
[2] Royal London Hosp, Retinoblastoma Serv, London, England
[3] Univ Washington, Dept Ophthalmol, Seattle, WA 98195 USA
[4] Great Ormond St Hosp Sick Children, Paediat Oncol Dept, London, England
[5] Barts Hlth NHS Trust, Dept Cellular Pathol, London, England
[6] Moorfields Eye Hosp NHS Fdn Trust, NIH, Res Biomed Res Ctr, London, England
[7] UCL, Inst Ophthalmol, London, England
关键词
CLINICAL-FEATURES; CHEMOTHERAPY; CHEMOREDUCTION; MANAGEMENT;
D O I
10.1016/j.ophtha.2017.01.048
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Purpose: To evaluate the rate and identify the risk factors for high-risk histopathologic features in group D retinoblastoma eyes enucleated as primary or secondary treatment. Design: Retrospective analysis. Participants: A total of 64 enucleated group D eyes (62 patients), of which 40 (40 patients) were primary and 24 (22 patients) were secondary to other treatments. Methods: Clinicopathologic correlation of consecutive group D eyes enucleated from 2002 to 2014. High-risk histopathologic features were defined as the presence of anterior chamber seeds, iris infiltration, ciliary body/muscle infiltration, massive (>= 3 mm) choroidal invasion, retrolaminar optic nerve invasion, or combined non-massive choroidal and prelaminar/laminar optic nerve invasion. Main Outcome Measures: High-risk histopathologic features, metastasis, and death. Results: Of the 64 group D eyes, 37 (58%) were classified as cT2bN0M0H0, 24 (38%) were classified as cT2bN0M0H1, and 3 (5%) were classified as cT2aN0M0H1, according to the 8th edition cTNMH Retinoblastoma Staging. High-risk histopathologic features were detected in 10 eyes (16%) in the entire cohort, 5 eyes (13%) of the primary enucleated group (pT3aNxM0, n = 2 and pT3bNxM0, n = 3, 8th edition pTNM), and 5 eyes (21%) of the secondary enucleated group (pT2bNxM0, n = 2, pT3aNxM0, n = 2 and pT3cNxM0, n = 1). Absence of vitreous seeds at presentation was the only predictive factor found for high-risk histopathologic features in the primary enucleation group (P = 0.042), whereas none were found in the secondary group (P = 0.179). Invasion of the anterior structures (anterior chamber, iris, ciliary body/muscle) was detected significantly more after secondary enucleation (P = 0.048). All patients with high-risk histopathologic features were treated with adjuvant chemotherapy, and no metastases were recorded in a median follow-up time of 73.2 months (mean, 71.5; range, 13.7-153.0). Conclusions: The choice of primary treatment for group D retinoblastoma should be carefully weighed, because according to this study, 13% of eyes harbor high-risk histopathologic features at presentation, with the absence of vitreous seeds being a potential risk factor. It is of special importance in group D eyes being considered for nonsystemic treatment, such as primary intraophthalmic artery chemotherapy. Secondary enucleated group D eyes with high-risk histopathologic features more commonly involved anterior structures, warranting meticulous clinical and histologic examinations for this subset of patients. (C) 2017 by the American Academy of Ophthalmology
引用
收藏
页码:851 / 858
页数:8
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