Authors (including presenting author) :
Wong ES (1)(2)(3), Choy W.C (1), Yuzhou Zhang YZ (1) , Wai Kit Chu WK (1)(2)(4), Chen LJ (1)(4)(5), Pang CP (1)(4), Jason C. Yam CS (1),(2),(3),(4),(5)
Affiliation :
1. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
2. Hong Kong Eye Hospital, Hong Kong SAR, China
3. Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong SAR, China
4. Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong
5. Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong.
Introduction :
Despite advancements in globe-preserving treatments, improvements in retinoblastoma outcomes are inconsistent across income levels and geographical locations.
Objectives :
We conduct a systemic review and meta-analysis to investigate trends in global retinoblastoma survival and globe preservation over the past 40 years. We also examine associated socioeconomic and healthcare (SEH) factors and global survival disparity.
Methodology :
We screened articles in any language in 10 databases published before 8/10/2021 that described retinoblastoma overall survival (OS) and/ or globe salvage (GS) . Between-study heterogeneities by income levels were assessed by mixed-effect meta-analysis. Associations of retinoblastoma outcome with SEH and factors for survival prediction were investigated by multivariable linear regressions.
Result & Outcome :
14,621 reports were screened and 315 studies were included for analysis, covering 38,130 patients from 80 regions globally presenting during 1980-2020. Both OS and GS improved significantly over the 4 decades (P=0.017 and 0.0003). Broad disparity was observed between high and low income countries. OS, GS and advanced intraocular stage GS correlated positively with income levels (R=0.361-0.691). Higher OS was associated with lower rural population percentage (P=0.0005), and lower GINI index (P=0.0001). Higher GS was associated with better healthcare financing and accessibility (P=0.030). Both were associated positively with education level (P=0.0024, P=0.02). Survival gaps were observed in Sub-Saharan Africa, Southeast and Southwest Asia.
In conclusion, retinoblastoma treatment outcomes have improved globally over the past decades but large disparity persists between high and low income countries with areas of major survival gaps identified. Targeted healthcare policy making with increased healthcare financing and accessibility are needed in LMIC and LIC to improve retinoblastoma outcomes globally.
