title: Diagnostic delay and sociodemographic predictors of stage at diagnosis and mortality in unilateral and bilateral retinoblastoma.
abstract: BACKGROUND
  More invasive retinoblastoma, characterized by increased morbidity and mortality, with lower rates of eye salvage and higher rates of extraocular dissemination, seems more prevalent in resource-poor countries. The relationship of diagnostic delay (lag time) and sociodemographic factors on the extent of disease at diagnosis has not been examined separately for unilateral and bilateral retinoblastoma.
  
  
  METHODS
  At diagnosis, consenting parents of 179 Mexican children with retinoblastoma were interviewed about initial symptoms and household demographic characteristics. Clinical presentation was classified using St. Jude's, International Staging System (ISS), and International Intraocular Retinoblastoma Classification (IIRC) criteria. Lag time (delay between noting symptoms and diagnosis) and sociodemographic factors were examined as predictors for higher stage at diagnosis and overall survival (OS).
  
  
  RESULTS
  In bilateral disease, lag time predicts stage at diagnosis using St. Jude's, and ISS criteria (P < 0.005 in multivariate regression), and OS (P < 0.05, Cox hazards), but not extent of intraocular disease (by IIRC). In unilateral disease, lag time predicts neither extent of disease (using ISS, St Jude's, and IIRC), nor OS. Indicators of prenatal poverty, including lower maternal education and the presence of dirt flooring in the home, predict more advanced disease by IIRC for bilateral retinoblastoma, and for unilateral by ISS, and St Jude's (P < 0.001) as well as OS (P < 0.05).
  
  
  CONCLUSIONS
  These results suggest unilateral and bilateral retinoblastoma differs in factors governing progression and extraretinal extension, possibly reflecting underlying biologic heterogeneity.
  
  
  CONCLUSIONS
  This demonstrates differing effect of social factors on extent of intra- and extraocular disease depending on laterality with implications for screening strategies.
authors: Authors' Affiliations: Departments of Ophthalmology, Pathology, and Oncology of the Hospital Infantil de Mexico Federico Gomez; Hospital de Pediatria, Centro Medico Siglo XXI, Instituto Mexicano de Seguro Social, Mexico City, Mexico; Departments of Biostatistics and Environmental Health Sciences; and Pediatrics (Division of Oncology), Columbia University, New York, New York.
authors: Marco A
authors: MA
authors: Ramírez-Ortiz
authors: M Veronica
authors: MV
authors: Ponce-Castañeda
authors: M Lourdes
authors: ML
authors: Cabrera-Muñoz
authors: Aurora
authors: A
authors: Medina-Sansón
authors: Xinhua
authors: X
authors: Liu
authors: Manuela A
authors: MA
authors: Orjuela
mesh_terms: D000328:Adult; D002675:Child, Preschool; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D012175:Retinoblastoma / Q000175:diagnosis* / Q000401:mortality*; D012959:Socioeconomic Factors; D015996:Survival Rate