Ramírez-Ortiz Marco A, Ponce-Castañeda M Veronica, Cabrera-Muñoz M Lourdes, Medina-Sansón Aurora, Liu Xinhua, Orjuela Manuela A
Authors' Affiliations: Departments of Ophthalmology, Pathology, and Oncology of the Hospital Infantil de Mexico Federico Gomez; Hospital de Pediatria, Centro Medico Siglo XXI, Instituto Mexicano de Seguro Social, Mexico City, Mexico; Departments of Biostatistics and Environmental Health Sciences; and Pediatrics (Division of Oncology), Columbia University, New York, New York.
Cancer Epidemiol Biomarkers Prev. 2014 May;23(5):784-92. doi: 10.1158/1055-9965.EPI-13-1069. Epub 2014 Feb 12.
More invasive retinoblastoma, characterized by increased morbidity and mortality, with lower rates of eye salvage and higher rates of extraocular dissemination, seems more prevalent in resource-poor countries. The relationship of diagnostic delay (lag time) and sociodemographic factors on the extent of disease at diagnosis has not been examined separately for unilateral and bilateral retinoblastoma.
At diagnosis, consenting parents of 179 Mexican children with retinoblastoma 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 sociodemographic 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 < 0.05, Cox hazards), 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 retinoblastoma, 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 differs in factors governing progression and extraretinal extension, possibly reflecting underlying biologic heterogeneity.
This demonstrates differing effect of social factors on extent of intra- and extraocular disease depending on laterality with implications for screening strategies.
侵袭性更强的视网膜母细胞瘤，其特征为发病率和死亡率增加，眼球挽救率较低且眼外扩散率较高，在资源匮乏国家似乎更为普遍。对于单侧和双侧视网膜母细胞瘤，尚未分别研究诊断延迟（滞后时间）和社会人口学因素与诊断时疾病程度之间的关系。
在诊断时，对179名患有视网膜母细胞瘤的墨西哥儿童的家长进行了访谈，询问其初始症状和家庭人口学特征。使用圣裘德儿童研究医院国际分期系统（ISS）和国际眼内视网膜母细胞瘤分类（IIRC）标准对临床表现进行分类。将滞后时间（注意到症状与诊断之间的延迟）和社会人口学因素作为诊断时更高分期和总生存期（OS）的预测因素进行研究。
在双侧疾病中，滞后时间可预测使用圣裘德儿童研究医院和ISS标准诊断时的分期（多因素回归中P<0.005）以及OS（P<0.05，Cox风险模型），但不能预测眼内疾病范围（根据IIRC）。在单侧疾病中，滞后时间既不能预测疾病范围（使用ISS、圣裘德儿童研究医院和IIRC标准），也不能预测OS。产前贫困指标，包括母亲教育程度较低和家中有泥土地面，可预测双侧视网膜母细胞瘤根据IIRC标准、单侧视网膜母细胞瘤根据ISS和圣裘德儿童研究医院标准的疾病进展更严重（P<0.001）以及OS更差（P<0.05）。
这些结果表明，单侧和双侧视网膜母细胞瘤在疾病进展和视网膜外扩展的影响因素方面存在差异，这可能反映了潜在的生物学异质性。
这表明社会因素对眼内和眼外疾病范围的影响因患侧不同而有所差异，对筛查策略具有启示意义。
