Abstract
Purpose :
The prognostic implications of choroidal invasion in retinoblastoma are not fully understood. In this study, we aim to assess and compare the all-cause and cause-specific mortality risk in retinoblastoma patients with no choroidal invasion, focal choroidal invasion, and massive choroidal invasion.
Methods :
A retrospective cohort study was conducted using a nationwide cancer database from the Surveillance, Epidemiology, and End Results registries of retinoblastoma cases between 2004-2015. Kaplan-Meier curves with log rank were generated for overall survival (OS) and cause-specific survival (CSS). All-cause mortality risk was analyzed via Cox proportional hazard models with adjustment for available age, gender, race, ethnicity, grade, and laterality data.
Results :
368 retinoblastoma cases were evaluated with an average (+/-SD) follow-up period of 65.3 (+/- 43.8) months. Within this cohort, 247 (67.1%) had no choroidal invasion, 90 (24.5%) had focal choroidal invasion, and 31 (8.4%) had massive choroidal invasion. The subgroups had no significant differences in any demographic or tumor characteristic variables. OS between no invasion (99.6%), focal invasion (98.9%), and massive invasion (87.1%) differed significantly via log rank test (P <0.001). In adjusted analysis, massive choroidal invasion (HR, 40.88; 95% CI, 2.46, 680.22; P =0.01), but not focal choroidal invasion (HR, 1.96; 95% CI, 0.12, 31.73; P =0.637), had a significantly higher all-cause mortality risk compared to the no choroidal invasion reference group. Similarly, CSS between no choroidal invasion (100%), focal choroidal invasion (100%), and massive choroidal invasion (87.1%) significantly differed (P <0.001), with all 4 events occurring in the massive invasion subgroup.
Conclusions :
Retinoblastoma cases with massive choroidal invasion carry a less favorable prognosis compared to those with no choroidal invasion. Individuals with only focal invasion, however, possess a similar mortality risk to those with no invasion. Understanding the significance associated with histopathologic features of retinoblastoma helps in prognosticating a patient’s clinical course and may guide appropriate management.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.