Chuandi Zhou1, Xuyang Wen2, Yi Ding2, Jingwen Ding3, Mei Jin4, Zhenyin Liu5, Sha Wang6, Minglei Han7, Hongfeng Yuan8, Yishuang Xiao9, Li Wu10, Jiancang Wang11, Yangjun Li12, Jiawei Yu13, Yuechun Wen14, Juan Ye15, Rong Liu16, Zhijun Chen17, Shangcai Xue18, Wei Lu19, Hongfei Liao20, Jizhe Cui21, Dan Zhu22, Fang Lu23, Song Tang24, Yu Wu25, Tseden Yangkyi26, Guanghong Zhang27, Miershalijiang Wubuli28, Huiyu Guo29, Xian Wang30, Yanjin He31, Xunlun Sheng32, Qing Wang33, Yingxiu Luo2, Jiayan Fan2, Jinlei Qi34, Zhangsheng Yu35, Jia Tan6, Jianhong Liang36, Xiantao Sun37, Liwen Jin38, Xinji Yang39, Jing Zhang40, Xunda Ji41, Junyang Zhao42, Renbing Jia43, Xianqun Fan44. 1. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China; Chuandi Zhou's current affiliation is Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China. 3. Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China. 4. Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China. 5. Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. 6. Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China. 7. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Ophthalmology, Qilu Children's Hospital of Shandong University, Jinan, China. 8. Department of Ophthalmology, Army Medical Center of PLA, Chongqing, China. 9. Department of Ophthalmology, Kunming Children's Hospital, Kunming, China. 10. Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China. 11. Department of Ophthalmology, Hebei Children's Hospital, Shijiazhuang, China. 12. Department of Ophthalmology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China. 13. Department of Ophthalmology, Harbin Children's Hospital, Harbin, China. 14. Department of Ophthalmology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, China. 15. Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. 16. Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 17. Department of Ophthalmology, Children's Hospital of Nanjing Medical University, Nanjing, China. 18. Department of Ophthalmology, Second Provincial People's Hospital of Gansu, Lanzhou, China. 19. Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, China. 20. Department of Ocular Trauma and Orbital Diseases, Affiliated Eye Hospital of Nanchang University, Nanchang, China. 21. Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China. 22. Department of Ophthalmology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China. 23. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China. 24. Department of Ophthalmology, Affiliated Shenzhen Eye Hospital of Ji-nan University, Shenzhen, China. 25. Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. 26. Department of Ophthalmology, Tibet Autonomous Region Eye Center, Tibetan Medicine Hospital, Lhasa, China. 27. Department of Ophthalmology, The General Hospital of Xinjiang Military Command of PLA, Urumchi, China. 28. Department of Ophthalmology, Kashgar Prefecture Second People's Hospital, Kashgar, China. 29. Department of Ophthalmology, Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China. 30. Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China. 31. Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China. 32. Department of Ophthalmology, NingXia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China. 33. Department of Ophthalmology, Qinghai University Affiliated Hospital, Xining, China. 34. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. 35. Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Department of Bioinformatics and Biostatistics, Shanghai Jiao Tong University, Shanghai, China. 36. Department of Ophthalmology, Peking University People's Hospital, Beijing, China. 37. Department of Ophthalmology, Henan Children's Hospital, Zhengzhou, China. 38. Department of Ophthalmology, Quanzhou Women's and Children's Hospital, Quanzhou, China. 39. Department of Ophthalmology, The General Hospital of Chinese People's Armed Police Forces, Beijing, China. 40. Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China. Electronic address: fejr@foxmail.com. 41. Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: jixunda2007@aliyun.com. 42. Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China. Electronic address: zhaojunyang@163.com. 43. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China. Electronic address: renbingjia@sjtu.edu.cn. 44. Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China. Electronic address: fanxq@sjtu.edu.cn.
Abstract
PURPOSE: This study attempted to estimate the impact of eye-preserving therapies for the long-term prognosis of patients with advanced retinoblastoma with regard to overall survival and ocular salvage. DESIGN: Retrospective cohort study covering all 31 provinces (38 retinoblastoma treating centers) of mainland China. PARTICIPANTS: One thousand six hundred seventy-eight patients diagnosed with group D or E retinoblastoma from January 2006 through May 2016. METHODS: Chart review was performed. The patients were divided into primary enucleation and eye-preserving groups, and they were followed up for survival status. The impact of initial treatment on survival was evaluated by Cox analyses. MAIN OUTCOME MEASURES: Overall survival and final eye preservation. RESULTS: After a median follow-up of 43.9 months, 196 patients (12%) died, and the 5-year overall survival was 86%. In total, the eyeball preservation rate was 48%. In this cohort, 1172 patients (70%) had unilateral retinoblastoma, whereas 506 patients (30%) had bilateral disease. For patients with unilateral disease, 570 eyes (49%) underwent primary enucleation, and 602 patients (51%) received eye-preserving therapies initially. During the follow-up (median, 45.6 months), 59 patients (10%) from the primary enucleation group and 56 patients (9.3%) from the eye-preserving group died. Multivariate Cox analyses indicated no significant difference in overall survival between the 2 groups (hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.85-1.84; P = 0.250). For patients with bilateral disease, 95 eyes (19%) underwent primary enucleation, and 411 patients (81%) received eye-preserving therapies initially. During the follow-up (median, 40.1 months), 12 patients (13%) from the primary enucleation group and 69 patients (17%) from the eye-preserving group died. For bilateral retinoblastoma with the worse eye classified as group E, patients undergoing primary enucleation exhibited better overall survival (HR, 2.35; 95% CI, 1.10-5.01; P = 0.027); however, this survival advantage was not evident until passing 22.6 months after initial diagnosis. CONCLUSIONS: Eye-preserving therapies have been used widely for advanced retinoblastoma in China. Patients with bilateral disease whose worse eye was classified as group E and who initially underwent eye-preserving therapies exhibited a worse overall survival. The choice of primary treatment for advanced retinoblastoma should be weighed carefully.
PURPOSE: This study attempted to estimate the impact of eye-preserving therapies for the long-term prognosis of patients with advanced retinoblastoma with regard to overall survival and ocular salvage. DESIGN: Retrospective cohort study covering all 31 provinces (38 retinoblastoma treating centers) of mainland China. PARTICIPANTS: One thousand six hundred seventy-eight patients diagnosed with group D or E retinoblastoma from January 2006 through May 2016. METHODS: Chart review was performed. The patients were divided into primary enucleation and eye-preserving groups, and they were followed up for survival status. The impact of initial treatment on survival was evaluated by Cox analyses. MAIN OUTCOME MEASURES: Overall survival and final eye preservation. RESULTS: After a median follow-up of 43.9 months, 196 patients (12%) died, and the 5-year overall survival was 86%. In total, the eyeball preservation rate was 48%. In this cohort, 1172 patients (70%) had unilateral retinoblastoma, whereas 506 patients (30%) had bilateral disease. For patients with unilateral disease, 570 eyes (49%) underwent primary enucleation, and 602 patients (51%) received eye-preserving therapies initially. During the follow-up (median, 45.6 months), 59 patients (10%) from the primary enucleation group and 56 patients (9.3%) from the eye-preserving group died. Multivariate Cox analyses indicated no significant difference in overall survival between the 2 groups (hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.85-1.84; P = 0.250). For patients with bilateral disease, 95 eyes (19%) underwent primary enucleation, and 411 patients (81%) received eye-preserving therapies initially. During the follow-up (median, 40.1 months), 12 patients (13%) from the primary enucleation group and 69 patients (17%) from the eye-preserving group died. For bilateral retinoblastoma with the worse eye classified as group E, patients undergoing primary enucleation exhibited better overall survival (HR, 2.35; 95% CI, 1.10-5.01; P = 0.027); however, this survival advantage was not evident until passing 22.6 months after initial diagnosis. CONCLUSIONS: Eye-preserving therapies have been used widely for advanced retinoblastoma in China. Patients with bilateral disease whose worse eye was classified as group E and who initially underwent eye-preserving therapies exhibited a worse overall survival. The choice of primary treatment for advanced retinoblastoma should be weighed carefully.
Authors: Anna Miroshnychenko; Dena Zeraatkar; Mark R Phillips; Sophie J Bakri; Lehana Thabane; Mohit Bhandari; Varun Chaudhary Journal: Eye (Lond) Date: 2022-01-13 Impact factor: 4.456