The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

The global challenges of the long COVID-19 in adults and children

Institución Universitaria Visión de las Américas. Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Risaralda, Colombia / Universidad Científica del Sur. Faculty of Health Sciences. Lima, Peru / Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia.Universidad Científica del Sur. Faculty of Health Sciences. Lima, Peru.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Lebanese American University. Gilbert and Rose-Marie Chagoury School of Medicine. Beirut, Lebanon.Municipal Autonomous Government of Cochabamba. Municipal Secretary of Health. Direction of First Level. Cochabamba, Bolivia.Franz Tamayo University. National Research Coordination. La Paz, Bolivia.Universidad Continental. Research Unit. Huancayo, Peru.Universidad Nacional de Colombia. Department of Pediatrics. Bogotá, DC, Colombia / Fundación HOMI. Hospital Pediátrico La Misericordia. Division of Infectious Diseases. Bogotá, DC, Colombia / Fundación Hospital Infantil Universitario de San José. Bogotá, DC, Colombia.Hemera Unidad de Infectología IPS SAS. Bogota, Colombia.Hospital San Vicente Fundación. Rionegro, Antioquia, Colombia.Clinica Imbanaco Grupo Quironsalud. Cali, Colombia / Universidad Santiago de Cali. Cali, Colombia / Clinica de Occidente. Cali, Colombia / Clinica Sebastián de Belalcazar. Valle del Cauca, Colombia.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina.Universidade Estadual Paulista Júlio de Mesquita Filho. Botucatu Medical School. Infectious Diseases Department. São Paulo, SP, Brazil / Brazilian Society for Infectious Diseases. São Paulo, SP, Brazil.Institute of Infectious Diseases Emilio Ribas. São Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil / Universidade Federal do Pará. Faculdade de Medicina. Belém, PA, Brazil.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina / Hospital de Enfermedades Infecciosas F. J. Muñiz. Buenos Aires, Argentina.University of Buenos Aires. Cátedra de Enfermedades Infecciosas. Buenos Aires, Argentina / Hospital de Enfermedades Infecciosas F. J. Muñiz. Buenos Aires, Argentina.Centro de Referencia de Salud Dr. Salvador Allende Gossens. Policlínico Neurología. Unidad Procedimientos. Santiago de Chile, Chile.Hospital Salvador Bienvenido Gautier. Santo Domingo, Dominican Republic.Universidad Central del Ecuador. Jefatura de Cátedra de Enfermedades Infecciosas. Quito, Ecuador.Universidad Autónoma de Santo Domingo. Santo Domingo, Dominican Republic.Hospital Roosevelt. Guatemala City, GuatemalaNational Autonomous University of Honduras. Institute for Research in Medical Sciences and Right to Health. Tegucigalpa, Honduras.National Clinical Coordinator COVID-19-WHO Studies. Colombia / Universidad Nacional de Colombia. Facultad de Medicina. Clinica Colsanitas. Clinica Universitaria Colombia. Colombia.Think Vaccines LLC. Houston, Texas, USA.Universidad Simón Bolívar. Centro de Investigación en Ciencias de la Vida. Barranquilla, Colombia / Grupo de Expertos Clínicos Secretaria de Salud de Barranquilla. Barranquilla, Colombia.Universidad San Ignacio de Loyola. Vicerrectorado de Investigación. Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru.Hospital Evangélico de Montevideo. Montevideo, Uruguay.Fundación Universitaria Autónoma de las Américas. Faculty of Medicine. Grupo de Investigación Biomedicina. Pereira, Colombia / University of California. School of Public Health. Division of Infectious Diseases and Vaccinology. Berkeley, CA, USA.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela.Universidad Central de Venezuela. Faculty of Medicine. Caracas, Venezuela / Biomedical Research and Therapeutic Vaccines Institute. Ciudad Bolivar, Venezuela.University of Colorado Anschutz Medical Campus. School of Medicine. Division of Infectious Diseases. Aurora, CO, USA.Tribhuvan University Teaching Hospital. Institute of Medicine. Kathmandu, Nepal / Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth. Dr. D. Y. Patil Medical College. Department of Microbiology. Pune, Maharashtra, India / Dr. D.Y. Patil Dental College and Hospital. Department of Public Health Dentistry. Dr. D.Y. Patil Vidyapeeth, Maharashtra, India.Universidad Cesar Vallejo. Escuela de Medicina. Trujillo, Peru.Universidad de San Martín de Porres. Facultad de Medicina Humana. Chiclayo, Peru.Friedrich Schiller University Jena. Institute of Microbiology. Beutenbergstraße, Jena, Germany / Pontificia Universidad Católica del Ecuador. School of Medicine. Postgraduate Program in Infectious Diseases. Quito, Ecuador.Universidad Simón Bolivar. Faculty of Health Sciences. Barranquilla, Colombia.Johns Hopkins Aramco Healthcare. Specialty Internal Medicine and Quality Department. Dhahran, Saudi Arabia / Indiana University School of Medicine. Department of Medicine. Infectious Disease Division. Indianapolis, IN, USA / Johns Hopkins University School of Medicine. Department of Medicine. Infectious Disease Division. Baltimore, MD, USA.Johns Hopkins Aramco Healthcare. Molecular Diagnostic Laboratory. Dhahran, Saudi Arabia / Alfaisal University. College of Medicine. Riyadh, Saudi Arabia / The University of Haripur. Department of Public Health and Nutrition. Haripur, Pakistan.VM Medicalpark Samsun Hospital. Department of Infectious Diseases. Samsun, Turkey.University of Miami. Miller School of Medicine. Department of Medicine. Division of Infectious Diseases. Miami, FL, USA.Caja Costarricense de Seguro Social. Centro de Ciencias Médicas. Hospital Nacional de Niños Dr. Carlos Sáenz Herrera. Servicio de Infectología Pediátrica. San José, Costa Rica / Instituto de Investigación en Ciencias Médicas. San José, Costa Rica / Universidad de Ciencias Médicas. Facultad de Medicina. Cátedra de Pediatría. San José, Costa Rica

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival

The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries

Background Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. Methods We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1,2017, and Dec 31,2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. Findings The cohort included 4064 children from 149 countries. The median age at diagnosis was 23.2 months (IQR 11.0-36.5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0.8%) of 636 children from high-income countries, 55 (5.4%) of 1027 children from upper-middle-income countries, 342 (19. 7%) of 1738 children from lower-middle-income countries, and 196 (42.9%) of 457 children from low-income countries. Enudeation surgery was available for all children and intravenous chemotherapy was available for 4014 (98.8%) of 4064 children. The 3-year survival rate was 99.5% (95% CI 98.8-100.0) for children from high-income countries, 91.2% (89.5-93.0) for children from upper-middle-income countries, 80.3% (78.3-82.3) for children from lower-middle-income countries, and 57.3% (524-63-0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16.67; 95% CI 4.76-50.00), cT4 advanced tumour compared to cT1 (8.98; 4.44-18.18), and older age at diagnosis in children up to 3 years (1.38 per year; 1.23-1.56). For children aged 3-7 years, the mortality risk decreased slightly (p=0.0104 for the change in slope). Interpretation This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Y

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society