Ophthalmology ( IF 13.1 ) Pub Date : 2021-09-15 , DOI: 10.1016/j.ophtha.2021.09.002 Chuandi Zhou 1 , Xuyang Wen 2 , Yi Ding 2 , Jingwen Ding 3 , Mei Jin 4 , Zhenyin Liu 5 , Sha Wang 6 , Minglei Han 7 , Hongfeng Yuan 8 , Yishuang Xiao 9 , Li Wu 10 , Jiancang Wang 11 , Yangjun Li 12 , Jiawei Yu 13 , Yuechun Wen 14 , Juan Ye 15 , Rong Liu 16 , Zhijun Chen 17 , Shangcai Xue 18 , Wei Lu 19 , Hongfei Liao 20 , Jizhe Cui 21 , Dan Zhu 22 , Fang Lu 23 , Song Tang 24 , Yu Wu 25 , Tseden Yangkyi 26 , Guanghong Zhang 27 , Miershalijiang Wubuli 28 , Huiyu Guo 29 , Xian Wang 30 , Yanjin He 31 , Xunlun Sheng 32 , Qing Wang 33 , Yingxiu Luo 2 , Jiayan Fan 2 , Jinlei Qi 34 , Zhangsheng Yu 35 , Jia Tan 6 , Jianhong Liang 36 , Xiantao Sun 37 , Liwen Jin 38 , Xinji Yang 39 , Jing Zhang 5 , Xunda Ji 40 , Junyang Zhao 4 , Renbing Jia 2 , Xianqun Fan 2
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.