Contemporary Update of Retinoblastoma in China: Three-Decade Changes in Epidemiology, Clinical Features, Treatments, and Outcomes

作者：Luo, Yingxiu; Zhou, Chuandi; He, Fanglin; Fan, Jiayan; Wen, Xuyang; Yi Ding; Han, Yanping; Ding, Jingwen; Mei Jin; Liu, Zhenyin; Sha Wang; Han, Minglei; Yuan, Hongfeng; Hong Sun; Xiao, Yishuang; Li Wu; Wang, Jiancang; Li, Yangjun; Yang, Huasheng; Yu, Jiawei; Gong, Jianyang; Xu, Yuxin; Wen, Yuechun; Gao, Ziqing; Mei, Lixin; Juan Ye; Hu Liu; Chen, Zhijun; Xue, Shangcai; Rong Liu; Hong Chen; Wei Lu; Liao, Hongfei; Qing Guo; Cui, Jizhe; Dan Zhu; Fang Lu; Song Tang; Yu Wu; Yangkyi, Tseden

来源：American Journal of Ophthalmology, 2022, 236: 193-203.

DOI：10.1016/j.ajo.2021.09.026

• CANCER
• CLASSIFICATION
• CHEMOTHERAPY
• SURVIVAL

PURPOSE: To report three-decade changes of clinical characteristics, progress of treatments, and risk factors associated with mortality and enucleation in patients with retinoblastoma in China. @@@ DESIGN: Retrospective cohort study. @@@ METHODS: This multicenter study included 2552 patients diagnosed with retinoblastoma in 38 medical centers in 31 provinces in China from 1989 to 2017, with follow-up data. Kendall's tau-b value was used to describe correlation coefficients between the three eras (between 1989 and 2008, between 2009 and 2013, and between 2014 and 2017) and clinical or demographic features. Hazard ratios and odds ratios were applied to measure risk factors. @@@ RESULTS: A total of 324 (13%) patients died and 1414 (42%) eyes were removed. The 1-year, 3-year, and 5-year overall survival rates were 95%, 86%, and 83%, respectively. Patients were diagnosed at a better stage by International Classification for Retinoblastoma over time (Kendall's tau-b value = -0.084, P < .001). Pathological risk factors were also observed less in recent eras. New conservative therapies were adopted and used in more patients. The eye removal rate gradually decreased (Kendall's tau-b value = -0.167, P < .001). The over all survival rates were 81%, 83%, and 91% in the three eras. By multivariate Cox regression, bilateral tumors and extraocular extension were identified as risk factors for death. Among intraocular disease, Group E indicated higher risk of mortality. By multivariate logistics regression, unilateral tumors, earlier era of diagnosis, and extraocular extension were risk factors for eye salvage failure. Among intraocular retinoblastoma, Groups D and E had higher risk of eye salvage failure. @@@ CONCLUSIONS: Patients were diagnosed at an earlier stage in recent eras. Conservative therapies, including intra-arterial chemotherapy, were increasingly being used. The above changes may contribute to the decreasing enucleation rate. Although no significant impact was identified on the mortality by the three eras, a decreasing trend was shown.

• 单位
  1; 北京大学; 武汉大学; 南昌大学; 山东大学; 上海交通大学; 中山大学; 哈尔滨医科大学; 安徽医科大学; 四川大学; 内蒙古医学院; 华中科技大学; 吉林大学; 浙江大学