Visual prognosis in retinoblastoma patients with multimodality treatments: Visual Prognosis in Retinoblastoma Patients

Abstract

Purpose: This study evaluates factors associated with globe preservation and long-term visual outcomes according to clinical characteristics and treatment modalities in intraocular retinoblastoma patients. Design: A retrospective review of medical records enrolled intraocular retinoblastoma patients between January 1, 2007, and June 30, 2020. Methods: • Setting: Single-centered. • Patient or study population: Intraocular retinoblastoma patients treated at Ramathibodi Hospital, Bangkok, Thailand. • Main outcome measure: A statistically significant factor associated with visual prognosis corresponds to baseline characteristics, staging, anatomical involvement, and multimodal treatments. Results: 86 patients (124 eyes) were included. Median age of disease bilaterality onset was significantly younger than unilaterality. Three-quarters of patients were in advanced stages (groups D or E in either ICRB or IIRC and up to cT2a from AJCC). Globe salvage rate was 54.0 % (67 eyes). ICRB Groups D-E, IIRC Groups D-E, and AJCC cT2a and more advanced stages are the globe removal-associated independent risk factors (adjusted odds ratio [AOR] [95 % CI] = 7.40 [1.36, 40.09], 8.33 [1.55, 44.73], 14.73 [1.55, 139.79], respectively). Compared to other classification, IIRC provided the highest statistical correlation from univariate analysis. IIRC Groups A-C is a good visual acuity-associated independent risk factor (AOR [95 % CI] = 4.64 [1.05, 20.43] and P = 0.042). Macular involvement is a worse visual acuity-associated independent risk factor (AOR [95 % CI] = 0.14 [0.02, 0.82] and P = 0.03). Systemic chemotherapy (86.29 %) is the mainstay treatment in our study and is the only good visual outcome-associated treatment. Subgroup analysis of all eyes receiving systemic chemotherapy reveals statistically significant preventive factors for globe removal for tumor staging with ICRB and IIRC groups A-C and AJCC stages cT1a–cT1b (odds ratio [95 % CI] = 15.75 [4.38, 56.65], 15.67 [4.34, 56.53], 9.97 [2.75, 36.18], respectively; P=<0.001) and prevents the worse visual outcome in these stages, (odds ratios [95 % CI] = 4.57 [1.28, 16.27], 6.61 [1.74, 25.11], and 7.50 [1.86, 30.16], respectively; P =< 0.05). Conclusions: All recent advanced clinical stagings are globe removal outcome-associated independent risk factors. IIRC staging is the best visual results predictor. IIRC Groups A-C were associated with a good visual outcome. Macular involvement tumors are strongly associated with poor visual outcome, despite successful globe preservation from multimodality treatment. Systemic chemotherapy remains a crucial globe-saving treatment and prevents worse vision–especially in ICRB and IIRC Groups A-C and AJCC stage cT1a-cT1b.