Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA.
Department of Pediatrics (Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation), Columbia University Medical Center, New York, New York, USA.
Cancer Rep (Hoboken). 2021 Dec;4(6):e1409. doi: 10.1002/cnr2.1409. Epub 2021 May 7.
Prior ecologic studies suggest that UV exposure through sunlight to the retina might contribute to increased retinoblastoma incidence.
Our study objectives were (1) to examine the relationship between exposure to sunlight during postnatal retinal development (prior to diagnosis of sporadic disease) and the risk of retinoblastoma, and (2) to examine the relationship between sun exposure during postnatal retinal development, and the extent of disease among children with unilateral and bilateral retinoblastoma.
We interviewed 511 mothers in the EpiRbMx case-control study about their child's exposure to sunlight during postnatal retinal cell division by examining three time periods prior to Rtb diagnosis coinciding with developmental stages in which outdoor activities vary. Weekly sun exposure was compared by age period, between unilateral (n = 259), bilateral (n = 120), and control (n = 132) children, accounting for two factors affecting UV exposure: residential elevation and reported use of coverings to shield eyes. For cases, association between sunlight exposure and clinical stage was examined by laterality at each age period. After adjusting for maternal education and elevation, sun exposure was lower in cases than controls in all three age periods especially during the first 6 months, and in children 12-23 months whose mothers did not cover their eyes when outdoors. In children diagnosed after 12 months of age, sun exposure during the second year of life (age 12-23 months) appeared inversely correlated (r = -0.25) with more advanced intraocular disease in bilateral Rtb children after adjusting for maternal education, residential elevation, and age of diagnosis (p < .09) consistent with effects of Vitamin D exposure on intraocular spread in earlier transgenic murine models of retinoblastoma, and suggesting potential chemopreventive strategies.
Sun exposure in early childhood is protective for retinoblastoma and may decrease degree of intraocular spread in children with bilateral Rtb.
先前的生态学研究表明，通过阳光照射视网膜的紫外线暴露可能会导致视网膜母细胞瘤发病率增加。
我们的研究目的是：(1) 检查出生后视网膜发育过程中（在散发性疾病诊断之前）暴露于阳光与视网膜母细胞瘤风险之间的关系；(2) 检查出生后视网膜发育过程中暴露于阳光与单侧和双侧视网膜母细胞瘤患儿疾病程度之间的关系。
我们在 EpiRbMx 病例对照研究中对 511 位母亲进行了访谈，询问了孩子在 Rtb 诊断前三个与户外活动变化相吻合的时期内，出生后视网膜细胞分裂过程中暴露于阳光的情况。每周的阳光暴露情况按年龄时期进行比较，比较了单侧（n=259）、双侧（n=120）和对照组（n=132）患儿之间的差异，这两个因素会影响紫外线暴露：居住地高度和报告的眼部遮蔽物的使用。对于病例，在每个年龄时期，根据单侧性，检查了阳光暴露与临床分期之间的关联。在调整了母亲的教育程度和居住地高度后，与对照组相比，所有三个年龄时期的病例组阳光暴露都较低，特别是在头 6 个月，以及在 12-23 个月大且其母亲在户外活动时未遮盖眼睛的儿童中。在 12 个月后诊断的儿童中，在调整了母亲的教育程度、居住地高度和诊断年龄后，第二年（12-23 个月）的阳光暴露与双侧 Rtb 儿童更晚期的眼内疾病呈负相关（r=-0.25），这与早期转基因视网膜母细胞瘤动物模型中维生素 D 暴露对眼内扩散的影响一致，表明存在潜在的化学预防策略。
儿童早期的阳光暴露对视网膜母细胞瘤具有保护作用，并且可能会降低双侧 Rtb 患儿眼内扩散的程度。
