title: A study of pathologic risk factors in postchemoreduced, enucleated specimens of advanced retinoblastomas in a developing country.
abstract: BACKGROUND
  Advanced cases of retinoblastoma are treated with chemoreduction followed by enucleation. Further adjuvant therapy is recommended in patients with known pathologic risk factors (PRFs).
  
  
  OBJECTIVE
  To determine the PRFs in enucleated specimens after chemoreduction and their association for adverse events of recurrence, metastasis, or death.
  
  
  METHODS
  This was a retrospective study of 77 enucleation specimens from patients treated between January 2000 and September 2008 with prior chemoreduction that were accessioned in the pathology department of a tertiary referral cancer center with an average follow-up of 24 months. Various PRFs were noted and their association with the development of an adverse event was recorded.
  
  
  RESULTS
  Of 77 patients, (male to female ratio, 51∶26), the incidence of overall PRF was 51.9%, and retrolaminar optic nerve invasion (32.5%), optic nerve cut margin (12.9%), massive choroidal invasion (26%), scleral invasion (23.4%), vitreous seedings (44.2%), and anterior segment invasion (20.8%). Undifferentiated tumor (>60%) was seen in 60.3% of cases (41 of 68 patients with differentiation available). Adverse event occurred in 18 of 72 patients with available follow-up (25%). Retrolaminar optic nerve invasion, optic nerve cut margin involvement, and scleral invasion were independent prognostic factors predicting the occurrence of an adverse event. Undifferentiated tumor (>60%) was a significant risk factor in univariate analysis, which is the unique feature in this study.
  
  
  CONCLUSIONS
  Classic PRF with the addition of a predominant presence from the undifferentiated component were associated with adverse outcomes in retinoblastoma treated with anterior chemotherapy. The latter may represent chemoresistant clones and more intensive adjuvant chemotherapy may be warranted in these patients.
authors.affiliation: Department of Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Suryawanshi
authors.forename: Mukta
authors.initials: M
authors.lastname: Ramadwar
authors.forename: Rajesh
authors.initials: R
authors.lastname: Dikshit
authors.forename: Shubhada V
authors.initials: SV
authors.lastname: Kane
authors.forename: Purna
authors.initials: P
authors.lastname: Kurkure
authors.forename: Shripad
authors.initials: S
authors.lastname: Banavali
authors.forename: Seethalakshmi
authors.initials: S
authors.lastname: Viswanathan
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D019572:Retinal Neoplasms / Q000401:mortality / Q000628:therapy*; D012175:Retinoblastoma / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate