Benign Tumors in Long-Term Survivors of Retinoblastoma.

Milo Van Hoefen Wijsard,Sara J Schonfeld,Annette C Moll,Jasmine H Francis,Johanna M Seddon,Flora E Van Leeuwen,Margaret A Tucker,Armida W Fabius,Lindsay M Morton,Ruth A Kleinerman,David H Abramson

doi:10.3390/cancers13081773

Abstract

Simple SummaryIt is well-established that hereditary retinoblastoma survivors have a substantially increased risk of developing subsequent malignant neoplasms (SMNs). Although clinicians have long suspected that this population is also at increased risk for developing benign neoplasms, the evidence is unclear. Benign tumors can substantially impact health status and quality of life, while raising questions for clinicians, when faced with a mass in a retinoblastoma survivor. By 60 years following retinoblastoma diagnosis, 17.6% of hereditary survivors had developed a benign tumor, with lipomas and leiomyomas being the most frequently diagnosed types. Additionally, we report both an increased risk of benign tumors after SMNs and a reciprocal increased risk of SMNs after benign tumors among hereditary retinoblastoma survivors. If confirmed, the large magnitude of the absolute risks and the association between benign tumors and SMNs in this population may have implications for long-term surveillance.Hereditary retinoblastoma survivors have substantially increased risk of subsequent malignant neoplasms (SMNs). The risk of benign neoplasms, a substantial cause of morbidity, is unclear. We calculated the cumulative incidence of developing benign tumors at 60 years following retinoblastoma diagnosis among 1128 hereditary (i.e., bilateral retinoblastoma or unilateral with family history, mutation testing was not available) and 924 nonhereditary retinoblastoma survivors diagnosed during 1914–2006 at two US medical centers with follow-up through 2016. Using Cox proportional hazards regression, we compared benign tumor risk by hereditary status and evaluated the association between benign tumors and SMNs. There were 100 benign tumors among 73 hereditary survivors (cumulative incidence = 17.6%; 95% confidence interval [CI] = 12.9–22.8%) and 22 benign tumors among 16 nonhereditary survivors (cumulative incidence = 3.9%; 95%CI = 2.2–6.4%), corresponding to 4.9-fold (95%CI = 2.8–8.4) increased risk for hereditary survivors. The cumulative incidence after hereditary retinoblastoma was highest for lipoma among males (14.0%; 95%CI = 7.7–22.1%) and leiomyoma among females (8.9%; 95%CI = 5.2–13.8%). Among hereditary survivors, having a prior SMN was associated with 3.5-fold (95%CI = 2.0–6.1) increased risk of developing a benign tumor; the reciprocal risk for developing an SMN after a benign tumor was 1.8 (95%CI = 1.1–2.9). These large-scale, long-term data demonstrate an increased risk for benign tumors after hereditary versus nonhereditary retinoblastoma. If confirmed, the association between benign tumors and SMNs among hereditary patients may have implications for long-term surveillance.

Highlights

Retinoblastoma is the most common primary intraocular malignancy in infancy and childhood
To improve our understanding of benign tumor occurrence among retinoblastoma survivors, we evaluated the risk for benign tumors in the National Cancer Institute LongTerm Follow-up Study of Retinoblastoma Survivors and whether the occurrence of benign tumors is associated with the occurrence of subsequent malignant neoplasms (SMNs)
Retinoblastoma was diagnosed at a younger age in hereditary survivors and treatment mostly consisted of radiotherapy (85.9%, with or without chemotherapy), whereas the majority of nonhereditary retinoblastoma survivors (68.8%) underwent surgical treatment alone

Summary

Introduction

Retinoblastoma is the most common primary intraocular malignancy in infancy and childhood. Patients with hereditary retinoblastoma carry a germline mutation in the RB1 gene and are at substantially increased risk of subsequent malignant neoplasms (SMNs) compared to patients with nonhereditary retinoblastoma and to the general population [1,2,3,4]. Previous reports, including one from our cohort, showed an excess of lipoma in patients with hereditary retinoblastoma compared to nonhereditary survivors [7,8,9], suggesting that germline RB1 mutations may contribute to benign tumor development. Lipomas can affect quality of life [10,11], uterine leiomyomas are responsible for heavy and prolonged menstrual bleeding and fertility issues [12], and in survivors of childhood cancer other than retinoblastoma, subsequent benign meningiomas have been shown to cause significant neurologic morbidity and even mortality [13]. Benign tumors can substantially impact health status and quality of life, while raising questions for clinicians when faced with a mass in a retinoblastoma survivor

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