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. 2023 Jan;107(1):127-132.
doi: 10.1136/bjophthalmol-2021-318892. Epub 2021 Aug 2.

Retinoblastoma seeds: impact on American Joint Committee on Cancer clinical staging

Ankit Singh Tomar  1 , Paul T Finger  2 , Brenda Gallie  3 , Tero Kivelä  4 , Ashwin Mallipatna  5   6 , Chengyue Zhang  7 , Junyang Zhao  7 , Matthew Wilson  8 , Rachel Brennan  9 , Michala Burges  8 , Jonathan Kim  10 , Jesse L Berry  11 , Rima Jubran  12 , Vikas Khetan  13 , Suganeswari Ganeshan  13 , Andrey Yarovoy  14 , Vera Yarovaya  14 , Elena Kotova  14 , Denis Volodin  14 , Yacoub Yousef  15 , Kalle Nummi  4 , Tatiana L Ushakova  16   17 , Olga V Yugay  16 , Vladimir G Polyakov  16   18 , Marco Antonio Ramirez-Ortiz  19 , Elizabeth Esparza-Aguiar  19 , Guillermo L Chantada  20 , Paula Schaiquevich  21 , Adriana C Fandiño  20 , Jason C Yam  22 , Winnie W Lau  23 , Carol P Lam  23 , Phillipa Sharwood  24 , Sonia Moorthy  25 , Quah Boon Long  26 , Vera Adobea Essuman  27 , Lorna A Renner  28 , Ekaterina Semenova  1 , Jaume Català-Mora  29 , Maria Correa Llano  29 , Elisa Carreras  29 ; American Joint Committee on Cancer Ophthalmic Oncology Task Force; American Joint Committee on Cancer Ophthalmic Oncology Task
Collaborators, Affiliations

Retinoblastoma seeds: impact on American Joint Committee on Cancer clinical staging

Ankit Singh Tomar et al. Br J Ophthalmol. 2023 Jan.

Abstract

Aim: To investigate whether the American Joint Committee on Cancer (AJCC) clinical category cT2b needs to be subclassified by the type and distribution of retinoblastoma (RB) seeding.

Methods: Multicentre, international registry-based data were collected from RB centres enrolled between January 2001 and December 2013. 1054 RB eyes with vitreous or subretinal seeds from 18 ophthalmic oncology centres, in 13 countries within six continents were analysed. Local treatment failure was defined as the use of secondary enucleation or external beam radiation therapy (EBRT) and was estimated with the Kaplan-Meier method.

Results: Clinical category cT2b included 1054 eyes. Median age at presentation was 16.0 months. Of these, 428 (40.6%) eyes were salvaged, and 430 (40.8%) were treated with primary and 196 (18.6%) with secondary enucleation. Of the 592 eyes that had complete data for globe salvage analysis, the distribution of seeds was focal in 143 (24.2%) and diffuse in 449 (75.8%). The 5-year Kaplan-Meier cumulative globe-salvage (without EBRT) was 78% and 49% for eyes with focal and diffuse RB seeding, respectively. Cox proportional hazards regression analysis confirmed a higher local treatment failure risk with diffuse seeds as compared with focal seeds (hazard rate: 2.8; p<0.001). There was insufficient evidence to prove or disprove an association between vitreous seed type and local treatment failure risk(p=0.06).

Conclusion: This international, multicentre, registry-based analysis of RB eyes affirmed that eyes with diffuse intraocular distribution of RB seeds at diagnosis had a higher risk of local treatment failure when compared with focal seeds. Subclassification of AJCC RB category cT2b into focal vs diffuse seeds will improve prognostication for eye salvage.

Keywords: neoplasia; pathology; retina; vitreous.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CONSORT flow diagram of all retinoblastoma eyes with vitreous seeding. CONSORT, Consolidated Standards of Reporting Trials; RB, retinoblastoma
Figure 2
Figure 2
Kaplan-Meier curve showing the cumulative proportion of salvaged eyes (without need for EBRT), by distribution of retinoblastoma seeding in clinical category cT2b eyes. EBRT, external beam radiation therapy.
Figure 3
Figure 3
Kaplan-Meier curve showing the cumulative proportion of salvaged eyes (without need for EBRT), by type of retinoblastoma vitreous seeding in clinical category cT2b eyes. EBRT, external beam radiation therapy.
See this image and copyright information in PMC

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