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

Yellagonga Regional Park wetlands water quality monitoring 2017/18 report

After a pilot study in 2010, which investigated the distribution of metals and nutrients within the Yellagonga Wetlands, a regular monitoring program was established. This monitoring program is also part of the Yellagonga Integrated Catchment Management plan. This monitoring program was extended to cover groundwater in 2013. Monitoring for both surface and groundwater is conducted and reported on annually. Monitoring programs have been refined over the years, with sites removed and added. A review of the monitoring data was undertaken in 2016. Ten groundwater bores were sampled in 2017/18 every two months and surface water quality was sampled at 11 sites monthly June to October, December and in April. A range of physico-chemical measurements, metals and nutrients are measured. Although in previous years, ground and surface waters have been reported separately, this year the reports for 2017/18 have been combined. The bores on the western side of the park show an increase in conductivity and related parameters in late summer, following evapo-concentration of solutes in the lakes. High concentrations of P and N were recorded in a number of the eastern bores (particularly Mid E Joondalup), suggesting groundwater is an important source of nutrients into the northern end of Lake Joondalup. All parameters recorded were compared to the ANZECC & ARMCANZ (2000) national water quality trigger values for the 95% protection of aquatic ecosystems. In 2017/2018 water quality was improved compared to previous years with only limited exceedances of guideline concentrations over slightly fewer elements (Al, As, and Zn). It appeared that groundwater was a major source of Al and Zn identified in the wetlands. Sulphate to chloride and sulphate to alkalinity ratios suggest that there are acid sulphate soils within the catchment, but that natural buffering within the system is preventing low pH and high metal concentrations. The presence of acidification is also evident in the eastern bores. There is clear evidence of an ongoing trend of lower pH across the entire system as recently reported in DOW monitoring. Key recommendations from the study are: a. to continue monitoring at the current frequency as this appears to be striking a balance between detail and cost. b. consideration of expanding or modifying the suite of metals/metalloids measured to better target potentially problematic elements. c. development of nutrient/water budgets for both Lakes Joondalup and Goollelal to better understand key sources of enrichment would assist with better targeting of management efforts to limit algal blooms. This is likely a focus of the Smart Cities project. d. acid sulphate soils remains an ongoing issue and further work to locate major sources would aid in their management. e. tracing the source of P in the drain between sites 4 and 6, as there are very high concentrations recorded on occasion. f. a new bore is proposed for the eastern side of Lake Goollelal to assist in identificationon nutrients entering the lak

Yellagonga Regional Park wetlands water quality monitoring 2016/17 report

Kinnear, Garnett et al. (1997) undertook a fifteen month study of the Yellagonga Park wetlands and concluded that they were eutrophic (enriched with nutrients) as a result of natural processes within the system and anthropogenic inputs. Lund, McCullough et al. (2011) and more recently Newport and Lund (2013) have confirmed acid sulphate soils present in the southern section of the park and metal contamination of wetlands in the Park. In the second, third and fourth years of monitoring Newport, Lund et al. (2011), Newport and Lund (2012), Newport and Lund (2013) reported that ANZECC/ARMCANZ (2000) water quality guidelines for the protection of aquatic systems were being exceeded for some physical parameters, nutrients and metals throughout the park’s surface waters.This report covers monitoring of the Yellagonga Park wetlands as per Newport and Lund (2013) for June 2016 to May 2017.All parameters recorded were compared to the ANZECC & ARMCANZ (2000) national water quality trigger values for the 95 % protection of aquatic ecosystems. In 2016/2017 water quality was improved compared to previous years with only limited exceedances of guideline concentrations over slightly fewer elements (Al, Cd, Hg, and Zn).Sulphate to chloride and sulphate to alkalinity ratios suggest that there are acid sulphate soils within the catchment, but that natural buffering within the system is preventing low pH and high metal concentrations. The low rainfall in 2015/16 did not result in metal release and obvious acidity in 2016/17. Despite this, there does appear to be an ongoing trend of lower pH across the entire system as recently reported in DOW monitoring.Recommendations from this report include supporting ongoing monitoring of the wetland system and further studies to improve management of water quality

Yellagonga Regional Park wetlands groundwater monitoring 2016/17 report

In 2012, MiWER completed a review of available groundwater data for the area surrounding the Yellagonga Regional Park. It identified the paucity of information relevant to management of the Park. In response, the City of Joondalup installed two bores on the eastern side of Lake Goollelal. In August 2012, MiWER commenced a groundwater monitoring program utilising the new bores and existing bores that were best located to gain an understanding of groundwater impacts on the Yellagonga wetlands. In 2014, two further bores were provided at Neil Hawkins Park and Ariti Avenue by the Cities. In 2016/17, monitoring of bores was reduced from monthly to bimonthly. Monitoring involved measurement of groundwater height, physico-chemical parameters, nutrient concentrations and selected metal/metalloid concentrations. Three bores were located on the eastern side of Lake Joondalup, two on the western side. Wallubuenup Swamp had one bore sampled on its eastern side and one on the western side. Two bores were sampled on the eastern side of Lake Goollelal and one on the western side. A total of ten bores throughout Yellagonga were sampled. This report covers monitoring from June 2016 to May 2017. The bores on the western side of the park show an increase in conductivity and related parameters in late summer, following evapo-concentration of solutes in the lakes. Ratios of sulphate to chloride and sulphate to alkalinity indicated the possible presence of ASS contamination at N.E. Goollelal, W. Wallubuenup, S.E. Joondalup and Mid E. Joondalup, although pH was not \u3c 5 or aluminium concentrations \u3e 1 mg L-1, these sites had some very high iron concentrations. Overall the likelihood of ASS contamination of these bores has increased since 2015/16. Metal concentrations such as Al, As, and Zn exceeded ANZECC & ARMCANZ (2000) guidelines for the 95 % protection of aquatic systems by up to an order of magnitude (10 times) on occasion. Concentrations of Al were however not at levels indicative of active ASS, although Fe concentrations were very high on occasion. The groundwater should continue to be monitored to keep a watch out for possible ASS problems which might necessitate management action. It appeared that groundwater was a source of Al and Zn identified in the wetlands. High concentrations of P and N were recorded in a number of the eastern bores (particularly Mid E Joondalup), suggesting groundwater is an important source of nutrients into the northern end of Lake Joondalup. Concentrations of P appear to have increased since 2015/16, although the distribution over time and between sites was very similar. Concentrations of N appear to have decreased slightly although lower organic N has been replaced with higher concentrations of the more problematic NOx. Key recommendations from the study are to continue monitoring at the current frequency as this appears to be striking a balance between detail and cost. A new bore is proposed for the eastern side of Lake Goollelal to assist in identification on nutrients entering the lake

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