This was a prospective cohort study of 692 treatment-naïve retinoblastoma (RB) patients from 10 countries followed up for 3 years from recruitment to evaluate the effect of lag time between diagnosis of RB and treatment. The mean lag time from the onset of the first symptom to visiting an RB treatment centre was 150 days. The mean follow-up duration was 26 months (median, 32 months; range, <1–51 months). Higher socioeconomic status of the country of residence was associated with a lower risk of enucleation: lower- to middle-income countries vs low-income countries (p<.001), upper-middle-income vs low-income countries (p=.009), and high-income countries vs low-income countries (p=.014). A greater American Joint Committee for Cancer (AJCC) stage was associated with a greater risk of enucleation: T2 vs T1 (p<.001) and T3 vs T1 (p<.001). Increased lag time (p<.001) and AJCC T4 stage (T4 vs T2; p<.001) were associated with increased risk of death. By Kaplan-Meier analysis, the cumulative incidence of enucleation at 3 months, 1 year and 3 years was 49%, 55% and 61%, respectively; and survival at 1, 2 and 3 years was 92%, 88% and 87%, respectively. Three-year Kaplan-Meier survival estimates were 95% with a lag time of <3 months vs 83% with a lag time of 3–12 months vs 62% with a lag time of >12 months. The authors concluded that lower socioeconomic status and greater AJCC stage were associated with an increased risk of enucleation. Increased lag time from the onset of the first symptom to visit the RB treatment centre and AJCC T4 stage were associated with an increased risk of death from RB. This study continues to highlight the inequalities in global healthcare diagnosis and treatment, and systemic surveillance and awareness needs to be prioritised.
Lag time between symptom onset and retinoblastoma treatment affects outcomes
Reviewed by Su Young
Lag time between onset of first symptom and treatment of retinoblastoma: outcomes at 3 years from recruitment.
CONTRIBUTOR
Su Young
Tennent Institute of Ophthalmology, NHS Greater Glasgow and Clyde, UK.
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