Analysis of the association between different treatments and high-risk histopathologic features of bilateral retinoblastomas_Chinese Journal of Ocular Fundus Diseases

Authors：

Deng Xun , Cheng Yong , Zhu Xuemei , Linghu Dandan , Zhao Mingwei ,  Liang Jianhong

Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China;

Corresponding author：

Liang Jianhong, Email: drliangjianhong@126.com

Keywords：

Retinoblastoma; Eye enucleation; Drug therapy, combination; High-risk histopathologic features

DOI：

10.3760/cma.j.cn511434-20220414-00215

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Objective To evaluate the pathological features of bilateral retinoblastoma (RB) and the relationship between different treatments and high-risk histopathologic features (HHF). Methods Retrospective series of case studies. From 1999 to 2018, 73 patients with binocular RB diagnosed by pathological examination in Department of Ophthalmology, Peking University People's Hospital were included in the study. Among them, 50 patients were male (68.5%, 50/73), 23 patients were females (31.5%, 23/73); 11 patitents had a family history of RB. The mean age at the first diagnosis was 14.8±15.6 months. The average time between first diagnosis and first intervention was 3.97±4.74 months. According to the international classification standard of intraocular RB staging, among the 73 eyes, C, D and E stages were 2 (2.7%, 2/73), 15 (20.5%, 15/73), and 56 (76.7%, 56/73) eyes, respectively. Ocular images for each patient were obtained using a wide-angle contact fundus camera during examination under general anaesthesia. The treatment protocol (globe salvaging or enucleation) depended on the result of several clinical features. Globe salvaging treatment included chemotherapy combined with local therapy such as intra-arterial chemotherapy (IAC), intravitreal chemotherapeutics injection, cryotherapy, laser, transpupillary thermotherapy and radiotherapy. If globe salvaging failed, enucleation was offered and histopathologic analysis was conducted of the enucleated eye, the ophthalmic pathologist read and evaluated the presence of HHF. Independent samples t-test was performed to compare the continuous variables. The pathological features and the relationship between different treatments and HHF were analyzed. Group difference was calculated with chi-square. Results Among the 73 eyes, the first treatment was enucleation in 21 eyes (28.8%, 21/73); 52 eyes (71.2%, 52/73) were treated with eye protection. After enucleation, 9 cases (12.3%, 9/73) had recurrence and metastasis, and 7 cases (9.6%, 7/73) died. The intervention time of patients with recurrence and metastasis and those without recurrence and metastasis were 7.4±7.3 and 3.5±4.1 months respectively; the first intervention time of patients with recurrence and metastasis was significantly later than that of patients without recurrence and metastasis, but the difference was not statistically significant (t=－1.561, P=0.154). The pathological examination results showed that there were 26 eyes (35.6%, 26/73) with HHF, 4 (26.7%, 15/26) and 22 (39.3%, 22/56) eyes were in stage D and E, respectively. Those who received other treatments before enucleation had lower HHF percentages after enucleation than those who did not receive corresponding treatments, but the difference was not statistically significant (χ²=1.852, 0.074, 0.000, 1.007, 0.007, 2.729; P＞0.05). Among the 26 eyes, 5 (83.3%, 5/6) and 21 (31.3%, 21/67) eyes were treated with systemic chemotherapy combined with and without IAC, respectively, and there was a significant difference in the percentage of HHF (χ²=4.422, P=0.035). Conclusions IAC eye-preserving therapy before enucleation has a significant effect on HHF.

Citation： Deng Xun, Cheng Yong, Zhu Xuemei, Linghu Dandan, Zhao Mingwei, Liang Jianhong. Analysis of the association between different treatments and high-risk histopathologic features of bilateral retinoblastomas. Chinese Journal of Ocular Fundus Diseases, 2022, 38(7): 568-572. doi: 10.3760/cma.j.cn511434-20220414-00215 Copy

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8.	Fabian ID, Stacey AW, Chowdhury T, et al. High-risk histopathology features in primary and secondary enucleated International Intraocular Retinoblastoma Classification Group D Eyes[J]. Ophthalmology, 2017, 124(6): 851-858. DOI: 10.1016/j.ophtha.2017.01.048.
9.	Brennan RC, Qaddoumi I, Billups CA, et al. Comparison of high-risk histopathological features in eyes with primary or secondary enucleation for retinoblastoma[J]. Br J Ophthalmol, 2015, 99(10): 1366-1371. DOI: 10.1136/bjophthalmol-2014-306364.
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11.	Wilson MW, Qaddoumi I, Billups C, et al. A clinicopathological correlation of 67 eyes primarily enucleated for advanced intraocular retinoblastoma[J]. Br J Ophthalmol, 2011, 95(4): 553-558. DOI: 10.1136/bjo.2009.177444.
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1. AlAli A, Kletke S, Gallie B, et al. Retinoblastoma for pediatric ophthalmologists[J]. Asia Pac J Ophthalmol (Phila), 2018, 7(3): 160-168. DOI: 10.22608/APO.201870.
2. Aerts I, Lumbroso-Le Rouic L, Gauthier-Villars M, et al. Retinoblastoma update[J]. Arch Pediatr, 2016, 23(1): 112-116. DOI: 10.1016/j.arcped.2015.09.025.
3. Linn Murphree A. Intraocular retinoblastoma: the case for a new group classification[J]. Ophthalmol Clin North Am, 2005, 18(1): 41-53. DOI: 10.1016/j.ohc.2004.11.003.
4. Kaliki S, Shields CL, Eagle RC Jr, et al. High-risk intraocular retinoblastoma: comparison between Asian Indians and Americans from two major referral centers[J]. Retina, 2018, 38(10): 2023-2029. DOI: 10.1097/IAE.0000000000001816.
5. 项晓琳, 李彬, 高飞, 等. 以眼球摘除术作为首次治疗的482例视网膜母细胞瘤患者的高危病理因素分析[J]. 中华眼科杂志, 2018, 54(10): 782-786. DOI: 10.3760/cma.j.issn.0412-4081.2018.10.012.Xu XL, Li B, Gao F, et al. Analysis of high-risk histopathologic features of 482 primarily enucleated retinoblastomas[J]. Chin J Ophthalmol, 2018, 54(10): 782-786. DOI: 10.3760/cma.j.issn.0412-4081.2018.10.012.
6. Xiao W, Ye H, Zeng H, et al. Associations among socioeconomic factors, lag time, and high-risk histopathologic features in eyes primarily enucleated for retinoblastoma[J]. Curr Eye Res, 2019, 44(10): 1144-1149. DOI: 10.1080/02713683.2019.1623898.
7. Kaliki S, Gupta S, Ramappa G, et al. High-risk retinoblastoma based on age at primary enucleation: a study of 616 eyes[J]. Eye (Lond), 2020, 34(8): 1441-1448. DOI: 10.1038/s41433-019-0698-2.
8. Fabian ID, Stacey AW, Chowdhury T, et al. High-risk histopathology features in primary and secondary enucleated International Intraocular Retinoblastoma Classification Group D Eyes[J]. Ophthalmology, 2017, 124(6): 851-858. DOI: 10.1016/j.ophtha.2017.01.048.
9. Brennan RC, Qaddoumi I, Billups CA, et al. Comparison of high-risk histopathological features in eyes with primary or secondary enucleation for retinoblastoma[J]. Br J Ophthalmol, 2015, 99(10): 1366-1371. DOI: 10.1136/bjophthalmol-2014-306364.
10. Alkatan HM, Al-Dahmash SA, Almesfer SA, et al. High-risk features in primary versus secondary enucleated globes with advanced retinoblastoma: a retrospective histopathological study[J]. Int Ophthalmol, 2020, 40(11): 2875-2887. DOI: 10.1007/s10792-020-01472-8.
11. Wilson MW, Qaddoumi I, Billups C, et al. A clinicopathological correlation of 67 eyes primarily enucleated for advanced intraocular retinoblastoma[J]. Br J Ophthalmol, 2011, 95(4): 553-558. DOI: 10.1136/bjo.2009.177444.
12. Shields CL, Lally SE, Leahey AM, et al. Targeted retinoblastoma management: when to use intravenous, intra-arterial, periocular, and intravitreal chemotherapy[J]. Curr Opin Ophthalmol, 2014, 25(5): 374-385. DOI: 10.1097/ICU.0000000000000091.
13. Dikkaya F, Sarıcı AM, Erbek F, et al. Evaluation of high-risk features of primary enucleation of patients with retinoblastoma in a tertiary center of a developing country in the era of intra-arterial chemotherapy[J]. Int Ophthalmol, 2018, 38(1): 151-156. DOI: 10.1007/s10792-016-0436-8.

Chinese Journal of Ocular Fundus Diseases

Analysis of the association between different treatments and high-risk histopathologic features of bilateral retinoblastomas

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