Diagnostic delay and sociodemographic predictors of stage at diagnosis and mortality in unilateral and bilateral retinoblastoma.
Diagnostic delay and sociodemographic predictors of stage at diagnosis and mortality in unilateral and bilateral retinoblastoma.
复制标题
DOI：
10.1158/1055-9965.epi-13-1069
复制
发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Orjuela MA
中科院分区：
文献类型：
--
作者：
Ramírez-Ortiz MA;Ponce-Castañeda MV;Cabrera-Muñoz ML;Medina-Sansón A;Liu X;Orjuela MA
More invasive retinoblastoma (Rb), characterized by increased morbidity and mortality, with lower rates of eye salvage and higher rates of extraocular dissemination, appears more prevalent in resource-poor countries. The relationship of diagnostic delay (lag time) and socio-demographic factors on the extent of disease at diagnosis has not been examined separately for unilateral and bilateral Rb. At diagnosis, consenting parents of 179 Mexican children with Rb were interviewed about initial symptoms and household demographic characteristics. Clinical presentation was classified using St. Jude’s, International Staging System (ISS), and International Intraocular Retinoblastoma Classification (IIRC) criteria. Lag time (delay between noting symptoms and diagnosis), and socio-demographic factors were examined as predictors for higher stage at diagnosis and overall survival (OS). In bilateral disease, lag time predicts stage at diagnosis using St. Jude’s, and ISS criteria (p<0.005 in multivariate regression), and OS (p<.05,CoxHazards), but not extent of intraocular disease (by IIRC). In unilateral disease, lag time predicts neither extent of disease (using ISS, St Jude’s and IIRC), nor OS. Indicators of prenatal poverty, including lower maternal education and the presence of dirt flooring in the home, predict more advanced disease by IIRC for bilateral Rb, and for unilateral by ISS, and St Jude’s (p<0.001) as well as OS (p<0.05). These results suggest unilateral and bilateral retinoblastoma differ in factors governing progression and extra-retinal extension, possibly reflecting underlying biological heterogeneity. This demonstrates differing effect of social factors on extent of intra- and extraocular disease depending on laterality with implications for screening strategies.
