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

Development of High Performance Industrial TCO Glass for Very Large Area a-Si:H PV Modules

The European project HELATHIS, executed by the five project partners signing this article, is dedicated to the improvement of the efficiency of very large area (5.7m2) silicon thin film photovoltaic (PV) modules. Optical confinement has been identified by the project partners as a major source for efficiency improvement of thin film silicon PV modules. One reason of the performance gap between highly efficient laboratory solar cells and industrial modules is the poorer electrical and optical performance of the industrial TCO-covered front glass substrate (TCO glass) which is investigated in this work. The glass substrate in industrial PV modules is about 3 times thicker than in laboratory solar cells where frequently Asahi U-type TCO glass (about 1 mm thick) is used. Therefore, the glass quality has an important impact on the transmission of industrial TCO glass. Reducing the iron-content in the float glass substrate increases the integrated transmission in the wavelength range from 400-800nm by nearly 2%. The electrical properties, namely the electrical carrier mobility, of the industrial TCO layer of AGC has been increased by about 15% by improving the industrial deposition process, resulting in a thinner TCO layer with higher transmission by maintaining the sheet resistance of about 9-10 /sq. Combining both developments the integrated transmission of industrial TCO glass has been increased by more than 2%. The TCO layer properties of Asahi U-type and standard industrial TCO glass (AGC AN10) have been investigated by SEM, AFM, XRD and ARS, showing that the Asahi U TCO scatters red light more effectively into larger angles