Survival among retinoblastoma patients at the Kenyatta National Hospital, Kenya

Abstract

Background: Retinoblastoma has a high cure rate if detected and treated early. Though there is paucity of data of the outcome of retinoblastoma management in Africa, literature shows wide disparity in survival between children with retinoblastoma in the developed and the developing countries. Objective: To estimate the 3 year survival of patients diagnosed with retinoblastoma at Kenyatta National Teaching and Referral Hospital, Kenya. Methods: This was a retrospective audit of records of patients admitted with retinoblastoma between January 2000 and December 2004. Demographic data, clinical presentation, intra-operative findings and histology report were recorded and parents/guardians were contacted to ascertain the patients’ outcome. The data was analyzed using the Statistical Package for Social Scientists version 12 and survival calculated using the Kaplan-Meier survival probability curve. Results: The cumulative 3-year survival was 26.6%. The mean survival time for the survivors was 68 months (SD 16.6) and the Kaplan-Meier survival probability at 36-months of follow-up was 0.2. The factors that significantly influenced good outcome were; age at presentation of <12 months, early disease at presentation (leucocoria only) OR=4.13(1.48-11.68) p<0.001, intraocular disease on histology OR=8.5(2.23-34.49) p<0.001 and total delay to management of ≤5 months OR=3.5(1.31-9.68) p=0.005. Proptosis and tumor recurrences were associated with 100% mortality. Conclusions: The survival of patients with retinoblastoma was found to be very low. The main reasons were the late presentation and recurrent disease. The factors associated with poor outcome were presentation with proptosis, metastatic disease, extraocular disease on histology and delay in diagnosis to management of >5months.