Do National Income Levels Impact Clinical Stage of Presentation of Retinoblastoma?

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Patients with retinoblastoma who come from low- and middle-income countries are more likely to be diagnosed at a later age and with more advanced disease compared to patients from high income countries, according to a study published in JAMA Oncology.

In this cross-sectional analysis of 4351 treatment-naive patients with retinoblastoma who were diagnosed in 2017, approximately 85% of patients were low- and middle-income countries.

Leukocoria, strabismus, and proptosis were the most common indication for referral accounting for 62.8%, 10.2%, and 7.4% of the study cohort, respectively.

In countries that were classified as high-income, the average age of diagnosis was 14.1 months, with 98.5% having intraocular retinoblastoma and <1 having metastasis.

In countries that were classified as low-income, the average age of diagnosis was 30.5 months, with 49.1% having extraocular retinoblastoma and 18.9% having metastasis.

A lower nation income level was linked to:

-Older age at presentation

-More locally advanced disease

-More distant metastasis

-A smaller proportion of familial history of retinoblastoma

The authors concluded that, “Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.



Global Retinoblastoma Study Group. Global retinoblastoma presentation and analysis by national income level. JAMA Oncol. 2020;6(5):685–695.


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