Browsing by Author "Shields, CL"

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High-risk histopathological features of retinoblastoma following primary enucleation: A Global Study Of 1,426 Patients From 5 Continents
(Lippincott Williams and Wilkins, 2024) Kaliki, S; Vempuluru, VS; Bakal, KR; Dorji, S; Tanna, V; Shields, CN; Fallon, SJ; Raval, V; Ahmad, A; Mushtaq, A; Hussain, M; Yousef, YA; Mohammad, M; Roy, SR; Huque, F; Tatiana, U; Yuri, S; Vladimir, P; Zambrano, SC; Alarcón-León, S; Valdiviezo-Zapata, C; Vargas-Martorellet, M; Gutierrez-Chira, C; Buitrago, M; Ortiz, JS; Diaz-Coronado, R; Tripathy, D; Rath, S; Patil, G; Berry, JL; Pike, S; Brown, B; Tanabe, M; Frenkel, S; Eiger-Moscovich, M; Pe'er, J; Shields, CL; Eagle, RC,, Jr; Laiton, A; Velasco, AM; Vega, K; Desimone, J; Bejjanki, KM; Kapoor, AG; Venkataraman, A; Bryant, V; Reddy, MA; Sagoo, MS; Hubbard, GB; Azarcon, CP; Olson, TA; Grossniklaus, H; Rolfe, O; Staffieri, SE; O'day, R; Mathew, AA; Elder, JE; Mckenzie, JD; Fabian, ID; Shemesh, R; Vishnevskia-Dai, V; Ali, MH; Jakati, S; Mishra, DK; Palkonda, VAR
Purpose: To evaluate high-risk histopathological features following primary enucleation of eyes with retinoblastoma and assess the patient outcomes across continents. Methods: A retrospective study of 1,426 primarily enucleated retinoblastoma eyes from five continents. Results: Of all, 923 (65%) were from Asia (AS), 27 (2%) from Australia (AUS), 120 (8%) from Europe (EUR), 162 (11%) from North America (NA), and 194 (14%) from South America (SA). Based on the continent (AS vs. AUS vs. EUR vs. NA vs. SA), the histopathological features included massive choroidal invasion (31% vs. 7% vs. 13% vs. 19% vs. 27%, P = 0.001), postlaminar optic nerve invasion (27% vs. 0% vs. 16% vs. 21% vs. 19%, P = 0.0006), scleral infiltration (5% vs. 0% vs. 4% vs. 2% vs. 7%, P = 0.13), and microscopic extrascleral infiltration (4% vs. 0% vs. <1% vs. <1% vs. 4%, P = 0.68). Adjuvant chemotherapy with/without orbital radiotherapy was given to 761 (53%) patients. Based on Kaplan-Meier estimates in different continents (AS vs. AUS vs. EUR vs. NA vs. SA), the 6-year risk of orbital tumor recurrence was 5% versus 2% versus 0% versus 0% versus 12% (P < 0.001), systemic metastasis was reported in 8% versus 5% versus 2% versus 0% versus 13% (P = 0.001), and death in 10% versus 3% versus 2% versus 0% versus 11% (P < 0.001) patients. Conclusion: There is a wide variation in the infiltrative histopathological features of retinoblastoma across continents, resulting in variable outcomes. SA and AS had a higher risk of orbital tumor recurrence, systemic metastasis, and death compared to AUS, EUR, and NA. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Neovascular Glaucoma as a Predictor of Retinoblastoma High-Risk Histopathology in an International Multicentre Study
(Lippincott Williams and Wilkins, 2024) Negretti, GS; Ushakova, T; Yuri, S; Vladimir, P; Berry, JL; Pike, S; Shields, CL; Hubbard, GB,, III; Eiger-Moscovich, M; Pe'er, J; Staffieri, SE; Elder, JE; McKenzie, JD; Ahmad, A; Hussain, M; Casavilca-Zambrano, S; Alarcon-Leon, S; Yousef, YA; Mohammad, M; Tanabe, M; Arazi, M; Fabian, ID; Goldstein, S; Kaliki, S; Sagoo, MS; Reddy, MA
Purpose: To assess histopathology and outcomes following primary enucleation of eyes with retinoblastoma presenting with neovascular glaucoma (NVG). Methods: This was an international multi-centre case series study across five continents. Retrospective review of patient charts was performed for all patients undergoing primary enucleation for retinoblastoma (n=1420) using a standardised data-collection spreadsheet. Clinical features, pathological grade, and outcomes were compared between NVG patients and those with an American Joint Commission on Cancer (AJCC) 8th edition clinical stage of cT2. High-risk histopathology was defined as AJCC 8th edition pathological stage ≥pT2b. Results: NVG was seen in 224/1420 (16%) patients. Mean age at presentation of those with NVG was 30 months (median 25, range 0-120 months) and 131(58%) patients had high-risk histopathology. The univariate logistic regression odds ratio for NVG predicting high-risk histopathology was 1.73 (95% confidence interval: 1.3 to 2.31) and from multivariate logistic regression was 1.77 (95% confidence interval: 1.23 to 2.56). Patients with a longer duration of symptoms (p=0.03), buphthalmos (p=0.02) and ectropion uveae (p<0.01) were more likely to have high-risk histopathology. Patients with NVG were more likely to develop metastasis than cT2 patients (p=0.04). Conclusions: There is a significant association between NVG at presentation, high-risk histopathology and metastatic risk.
Retinoblastoma Outcomes Based on the 8th Edition American Joint Committee on Cancer Pathological Classification in 1411 Patients
(Elsevier Inc., 2024) Vempuluru, VS; Shields, CL; Berry, JL; Kaliki, S; Ahmad, A; Bejjanki, KM; Diaz-Coronado, R; Eiger-Moscovich, M; Elder, JE; Fabian, ID; Frenkel, S; Grossniklaus, H; Hubbard, GB,, III; Kapoor, AG; Mohammad, M; McKenzie, JD; Pe'er, J; Rath, S; Reddy, MA; Rolfe, O; Roy, SR; Sagoo, MS; Staffieri, SE; Tanabe, M; Tatiana, U; Tripathy, D; Vishnevskia-Dai, V; Vladimir, P; Yousef, YA
Purpose: To evaluate the outcomes of retinoblastoma (RB) based on the 8th edition of the American Joint Committee on Cancer (AJCC) pathological classification in a global cohort of patients. Design: Retrospective, multicenter, intercontinental, collaborative study. Participants: A total of 1411 patients. Intervention: Primary enucleation with or without adjuvant chemotherapy or radiotherapy. Main Outcome Measures: Orbital tumor recurrence, tumor-related metastasis, and tumor-related death. Results: According to the 8th edition AJCC pathological classification, 645 eyes (46%) belonged to pathological T (pT)1, 164 (11%) to pT2, 493 (35%) to pT3, and 109 (8%) to pT4 categories. At a mean follow-up of 38 months (median, 35 months; < 1–149 months), orbital tumor recurrence was seen in 8 (1%), 5 (3%), 22 (4%), and 25 (23%) of pT1, pT2, pT3, and pT4 (P < 0.001) categories, respectively; tumor-related metastasis was seen in 7 (1%), 5 (3%), 40 (8%), and 46 (43%) of pT1, pT2, pT3, and pT4 (P < 0.001) categories, respectively; tumor-related death was seen in 12 (2%), 7 (4%), 64 (13%), and 64 (59%) of pT1, pT2, pT3, and pT4 (P < 0.001) categories, respectively. Multivariate Cox proportional hazards analysis of outcomes revealed pT category and adjuvant therapy as independent predictors of outcomes. Categories pT3b (P = 0.005), pT3c (P < 0.001), pT3d (P < 0.001), and pT4 (P < 0.001) had a greater hazard for orbital recurrence; categories pT2a (P = 0.015), pT3a (P < 0.001), pT3b (P < 0.001), pT3c (P < 0.001), pT3d (P < 0.001), and pT4 (P < 0.001) had a greater hazard for tumor-related metastasis; and categories pT2a (P = 0.068), pT2b (P = 0.004), pT3a (P < 0.001), pT3b (P < 0.001), pT3c (P < 0.001), pT3d (P < 0.001), and pT4 (P < 0.001) had a greater hazard for tumor-related death when compared with the pT1 category. Patients who did not receive adjuvant therapy had greater hazards of orbital tumor recurrence in categories pT3b (P = 0.005), pT3c (P = 0.003), and pT4 (P = 0.002); greater hazards of tumor-related metastasis in categories pT3a (P = 0.001), pT3b (P = 0.01), pT3c (P = 0.001), and pT4 (P = 0.007); and tumor-related death in categories pT3a (P < 0.001), pT3b (P = 0.009), pT3c (P = 0.018), and pT4 (P < 0.001) when compared with those who received adjuvant therapy. Conclusions: The 8th edition AJCC pathological classification predicts outcomes in patients undergoing primary enucleation for RB, and adjuvant therapy is associated with a lower risk of orbital recurrence, tumor-related metastasis, and tumor-related death in the pT3 and pT4 categories. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.