Survival among retinoblastoma patients at Kenyatta National Hospital: A retrospective audit.

Abstract

Aim The purpose of this study was to estimate the survival of patients with retinoblastoma admitted at Kenya's national referral hospital, The Kenyatta National Hospital. The information obtained will provide a good audit into the management of retinoblastoma in our country. Methods The study was a retrospective audit and was carried out at the Kenyatta National Hospital. All records of patients admitted with retinoblastoma in the period January 2000 to December 2004 were retrieved using ICD9 coding system. The files were coded 69.2 for retinoblastoma. Demographic data,c1inical presentation, intraoperative finding and histology report were recorded in a provided questionnaire. Patient or their next of kin were contacted in order to find out the outcome of the disease. The data was stored in a computer for analysis and analysis carried out using the Statistical Package for Social Scientists (SPSS) version 12. Results The cumulative 3-year survival rate was found to be 26.6%. The mean survival time for the 3- year survivors was 68 months (SD 16.6) and the Kaplan-Meier survival probability at 36-months follows up was 0.2. The factors that significantly influenced good outcome were; age at presentation of <12 months, early disease at presentation (Ieucocoria only) 4.13(1.48-11.68) p<0.00l, intraocular disease on histology (compared with extraocular disease) 8.5(2.23-34.49) p<0.00l and total delay to management of ,≤5 months 3.5(1.31-9.68) p=0.005. Proptosis and tumor recurrences were associated with 100% mortality. Multivariate analysis found early disease at presentation (Ieucocoria only) and intraocular disease on histology to significantly affect good outcome. Accuracy in correlating intraoperative findings with histopathological report was found to be 69.9%. Only 48% of the histologies were reported within two week of the surgical intervention. Conclusions The survival rate of patients treated for retinoblastoma was found to be very low compared to findings in studies done in the developed countries and developing countries outside Africa. The main reasons were the late presentation and presentation with recurrent disease. The factors associated with poor outcome were presentation with advanced or metastatic disease, extraocular disease on histology and total delay to management of more than five months. The accuracy in correlating the intraoperative findings with histopathological findings was moderate.