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

An Important Reserve of Improving the Assessment and Industrial Development of Large Complex Ore Deposits of Non-ferrous, Noble and Rare Metals (Uzbekistan)

The article discusses the issues of increasing the efficiency of geological and economic assessment and development of large complex fields in floating conditions on the example of the Almalyk group of fields. It is shown that the application of a fundamentally new optimized complex-system-dynamic and situational approach to the assessment of deposits increases the commercial, open-pit mined reserves of complex noble-color-rare-metal-porphyry ores of the Almalyk group deposits by four times. These results made it possible to substantiate the construction of a new processing complex, additional to the existing mining and processing plant (AGMK), based on the development for the Dalneye (Yoshlik-1) developmen

Oncologic Outcomes of Pelvic Bone Sarcomas Surgical

Despite the development and implementation of new regimens and methods of adjuvant therapy, one of the complex problems of modern oncology is the treatment of Malignant tumours of the pelvic bones, which is reflected in low survival rates and a high percentage of postoperative complications. The article provides a review of the literature on the problem of diagnosis, pathology, and preoperative planning of intraoperative navigation with the definition of the resection zone in pelvic bone sarcomas. Due to the complex anatomical structure of the pelvis, as well as the rare occurrence of pelvic bone sarcomas, a single approach to the treatment of this category of patients has not been developed. The authors conducted a deep analysis of the effectiveness of various types of reconstructive operations from 4 types of pelvic bone resections, depending on the location of the tumour

EPIDEMIOLOGY ANALYSIS OF TREATED PATIENTS WITH SKIN LEISHAMIZAM IN DJIZAK REGION (UZBEKISTAN)

According to official data, the incidence of cutaneous leishmaniasis is the last 5 years; in endemic areas, Uzbekistan is growing markedly. Given the increase in the incidence rate among the population of the republic, it is necessary to conduct an annual epidemiological analysis of the detection and spread of this disease, with the aim of timely monitoring and prevention. [1,4,5

Epidemiology Analysis Of Treated Patients With Skin Leishamizam In Djizak Region (Uzbekistan)

According to official data, the incidence of cutaneous leishmaniasis is the last 5 years; in endemic areas, Uzbekistan is growing markedly. Given the increase in the incidence rate among the population of the republic, it is necessary to conduct an annual epidemiological analysis of the detection and spread of this disease, with the aim of timely monitoring and prevention. [1,4,5