Global Retinoblastoma Presentation and Analysis by National Income Level.

Area of Science:

• Ophthalmology
• Pediatric Oncology
• Global Health

Background:

• Retinoblastoma is the most common intraocular cancer in children.
• Early diagnosis is crucial for saving a child's life and vision.
• Anecdotal evidence suggests late diagnoses are common globally, but this has not been systematically assessed.

Purpose of the Study:

• To determine the global stage of retinoblastoma at diagnosis.
• To examine the relationship between clinical variables and national income levels.
• To identify risk factors for advanced retinoblastoma at diagnosis.

Main Methods:

• A cross-sectional analysis of treatment-naive retinoblastoma patients diagnosed in 2017.
• Data collected from 278 treatment centers across 153 countries.
• Key outcomes measured: age at presentation, familial history, tumor stage, and metastasis.

Main Results:

• 4351 patients were included, with 84.7% from low- and middle-income countries (LMICs).
• Patients in high-income countries (HICs) were diagnosed younger (median 14.1 months) with less advanced disease compared to those in LMICs (median 30.5 months).
• Lower national income was significantly associated with older age at diagnosis, higher rates of locally advanced disease and distant metastasis, and a lower proportion of familial history.

Conclusions:

• The global burden of retinoblastoma lies in LMICs, where children present with older age and more advanced disease.
• Disparities in diagnosis and treatment necessitate urgent national and international interventions.
• Further research is needed to understand factors contributing to advanced disease in LMICs beyond age at presentation.