Metastasis-related mortality rates after retinoblastoma are tied to lower national income

In this paper, researchers compared retinoblastoma treatment outcomes in patients worldwide.

Study design

This retrospective, registry-based case series included 2,190 patients with retinoblastoma at 18 centers in 13 countries during a 12-year period. Researchers collected registry information such as staging and treatment, and assessed outcomes based on country. Using the 2017 United Nations World Population Prospects, countries were classified as high-income, upper-middle income, and lower-middle income. The main outcomes were metastasis-related mortality and local treatment failure.

Outcomes

Most study participants (60%) lived in upper and lower middle-income countries and tended to have a higher median age at diagnosis than children living in high-income countries. In addition, children in upper and lower middle-income countries had a 9- to 10-fold higher rate of metastasis-related mortality and 2-fold higher rate of local treatment failure.

Limitations

This retrospective case series spanned a 13-year period during which there were significant treatment advances in high-income countries, such as intra-arterial chemotherapy. The study did not include countries from the low-income category.

Clinical significance

Similar to findings from the Global Retinoblastoma Study Group in 2017, this study found little improvement in retinoblastoma outcomes, especially in upper and lower middle-income countries. In countries with more limited resources, the higher rate of metastasis-related mortality indicated a greater need for curative frontline treatments. Attention to earlier retinoblastoma detection and diagnosis should be emphasized in physician education worldwide.