Perinatal characteristics and risk of neuroblastoma

Pyrazole-Enriched Cationic Nanoparticles Induced Early- and Late-Stage Apoptosis in Neuroblastoma Cells at Sub-Micromolar Concentrations

Neuroblastoma (NB) is a severe form of tumor occurring mainly in young children and originating from nerve cells found in the abdomen or next to the spine. NB needs more effective and safer treatments, as the chance of survival against the aggressive form of this disease are very small. Moreover, when current treatments are successful, they are often responsible for unpleasant health problems which compromise the future and life of surviving children. As reported, cationic macromolecules have previously been found to be active against bacteria as membrane disruptors by interacting with the negative constituents of the surface of cancer cells, analogously inducing depolarization and permeabilization, provoking lethal damage to the cytoplasmic membrane, and cause loss of cytoplasmic content and consequently, cell death. Here, aiming to develop new curative options for counteracting NB cells, pyrazole-loaded cationic nanoparticles (NPs) (BBB4-G4K and CB1H-P7 NPs), recently reported as antibacterial agents, were assayed against IMR 32 and SHSY 5Y NB cell lines. Particularly, while BBB4-G4K NPs demonstrated low cytotoxicity against both NB cell lines, CB1H-P7 NPs were remarkably cytotoxic against both IMR 32 and SHSY 5Y cells (IC50 = 0.43–0.54 µM), causing both early-stage (66–85%) and late-stage apoptosis (52–65%). Interestingly, in the nano-formulation of CB1H using P7 NPs, the anticancer effects of CB1H and P7 were increased by 54–57 and 2.5–4-times, respectively against IMR 32 cells, and by 53–61 and 1.3–2 times against SHSY 5Y cells. Additionally, based on the IC50 values, CB1H-P7 was also 1-12-fold more potent than fenretinide, an experimental retinoid derivative in a phase III clinical trial, with remarkable antineoplastic and chemopreventive properties. Collectively, due to these results and their good selectivity for cancer cells (selectivity indices = 2.8–3.3), CB1H-P7 NPs represent an excellent template material for developing new treatment options against NB.

Maternal anemia and the risk of childhood cancer: A population-based cohort study in Taiwan

BACKGROUND

Childhood cancer may be related to maternal health in pregnancy. Maternal anemia is a common condition in pregnancy, especially in low-income countries, but the association between maternal anemia and childhood cancer has not been widely studied.

OBJECTIVE

To examine the potential relation between maternal anemia during pregnancy and childhood cancers in a population-based cohort study in Taiwan.

METHODS

We examined the relationship between maternal anemia and childhood cancer in Taiwan (N = 2160 cancer cases, 2,076,877 noncases). Cases were taken from the National Cancer Registry, and noncases were selected from birth records. Using national health registries, we obtained maternal anemia diagnoses. We estimated the risks for childhood cancers using Cox proportional hazard analysis.

RESULTS

There was an increased risk of cancers in children born to mothers with nutritional anemia (hazard ratio (HR): 1.32, 95% CI 0.99, 1.76). Iron deficiency anemia (HR: 1.30, 95% CI 0.97-1.75) carried an increased risk, while non-nutritional anemias were not associated with childhood cancer risk.

CONCLUSION

Our results provide additional support for screening for anemia during pregnancy. Adequate nutrition and vitamin supplementation may help to prevent some childhood cancer.

Maternal anemia and childhood cancer: a population-based case-control study in Denmark

BACKGROUND

Childhood cancer risk is associated with maternal health during pregnancy. Anemia in pregnancy is a common condition, especially in low-income countries, but a possible association between maternal anemia and childhood cancer has not been widely studied.

METHODS

We examined the relation in a population-based study in Denmark (N = 6420 cancer cases, 160,485 controls). Cases were taken from the Danish Cancer Registry, and controls were selected from national records. We obtained maternal anemia diagnoses from the National Patient and Medical Births registries. In a separate analysis within the years available (births 1995-2014), we examined cancer risks among mothers taking prescribed vitamin supplements, using data from the National Prescription Register. We estimated the risks of childhood cancer using conditional logistic regression.

RESULTS

The risks of neuroblastoma [odds ratio (OR= 1.83, 95% confidence interval (CI): 1.04, 3.22] and acute lymphoblastic leukemia (OR= 1.46, 95% CI 1.09, 1.97) were increased in children born to mothers with anemia in pregnancy. There was a two-fold increased risk for bone tumors (OR= 2.59, 95% CI: 1.42, 4.72), particularly osteosarcoma (OR= 3.54, 95% CI 1.60, 7.82). With regards to prescribed supplement use, mothers prescribed supplements for B12 and folate deficiency anemia (OR= 4.03, 95% CI 1.91, 8.50) had an increased risk for cancer in offspring.

CONCLUSION

Our results suggest that screening for anemia in pregnancy and vitamin supplementation may be an actionable strategy to prevent some cases of childhood cancer.

Mapping evidence on the risk factors associated with pediatric cancers in sub-Saharan Africa: a scoping review

BACKGROUND

The rarity and heterogeneity of pediatric cancers make it difficult to assess risk factors associated with the development of cancer in this group. This also determines the quantity and quality of evidence for etiological factors linked to pediatric cancers. Evidence on the risk factors associated with pediatric cancers is scarce; however, it has been accumulating slowly over the years. As the disease burden shifts from communicable to non-communicable diseases, most of these low- to middle-income countries (LMICs) find themselves overburdened with changing health care priorities and needs. In sub-Saharan Africa, it is of major importance to pay particular attention to risk factors associated with pediatric cancer.

OBJECTIVE

To map evidence on risk factors associated with pediatric cancers in sub-Saharan Africa (SSA).

METHODS

This review was guided by Arksey and O'Malley's framework for conducting scoping reviews. Four electronic databases were searched in December 2018, and another manual search was conducted in February 2022 to include newly published eligible articles. The databases searched included PubMed and Health Source: Nursing/Academic Edition. We also searched articles from an academic search engine, Google scholar. This review included articles reporting the relevant outcomes of this study and articles reporting cancers in children in the 0-15 years age range. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR): checklist and explanation.

RESULTS

We retrieved 7391 articles from the initial database. The final number of studies that were included for data extraction was 15. Evidence from the retrieved studies suggests that most childhood cancers in the SSA region are infection-induced. The type of cancer mostly reported is Burkitt Lymphoma and is diagnosed mostly in the tropical region of SSA. The type of risk factors was divided into three types: infection-induced, genetic, and demographic risk factors. Overall, based on the articles retrieved, there was limited evidence on the risk factors associated with pediatric cancers in SSA.

CONCLUSION

The limited evidence on the risk factors coupled with the lack of evidence on the true burden of these malignancies in the SSA hampers efforts to set priorities for childhood cancer control. Formulation of effective preventative (where possible) measures and treatment regimens will need proper assessment of risk factors.

Maternal lifestyle factors and risk of neuroblastoma in the offspring: A meta-analysis including Greek NARECHEM-ST primary data

The etiology of childhood neuroblastoma remains largely unknown. In this systematic review and meta-analysis, we summarized and quantitatively synthesized published evidence on the association of maternal modifiable lifestyle factors with neuroblastoma risk in the offspring. We searched MEDLINE up to December 31, 2020 for eligible studies assessing the association of maternal smoking, alcohol consumption and nutritional supplementation during pregnancy with childhood (0-14 years) neuroblastoma risk. Random-effects models were run, and summary odds ratios (OR) and 95% confidence intervals (95% CI) on the relevant associations were calculated, including estimates derived from primary data (n = 103 cases and n = 103 controls) of the Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) case control study (2009-2017) in Greece. Twenty-one eligible studies amounting 5163 cases participating in both case-control and cohort/linkage studies were included in the meta-analysis. Maternal smoking and alcohol consumption were not statistically significantly associated with neuroblastoma risk (summary ORsmoking: 1.08, 95% CI: 0.96-1.22, I2 =12.0%, n = 17 studies; summary ORalcohol: 1.01, 95% CI: 0.82-1.18, I2 =0.0%, n = 8 studies). By contrast, maternal vitamin intake during pregnancy was associated with significantly lower neuroblastoma risk (summary OR: 0.57, 95% CI: 0.34-0.95, I2 =58.9%, n = 4 studies). The results of the largest to-date meta-analysis point to an inverse association between vitamin intake during pregnancy and childhood neuroblastoma risk. Future longitudinal studies are needed to confirm and further specify these associations as to guide preventive efforts on modifiable maternal risk factors of childhood neuroblastoma.

Tobacco, alcohol and illicit drugs during pregnancy and risk of neuroblastoma: systematic review

OBJECTIVE

To determine whether prenatal and perinatal maternal consumption of alcohol, tobacco and/or illicit drugs is associated with risk of neuroblastoma.

DATA SOURCES

Medline and Embase (both from inception to February 2017), and reference lists of included studies.

STUDY SELECTION

To be eligible, a study had to be an original report including data on intake of alcohol, tobacco smoking and/or consumption of illicit drugs during pregnancy and risk of neuroblastoma in the child.

DATA EXTRACTION

From eligible studies, data study characteristics as well as effect measures and confounders were extracted. We assessed unadjusted and confounder-adjusted estimates, performed risk of bias analysis, constructed random-effects models and assessed heterogeneity.

RESULTS

We identified 14 case-control studies (1987-2016) involving a total of 3114 children with neuroblastoma. Meta-analysis of unadjusted estimates showed an association between alcohol (OR 1.26; 95% CI 1.07 to 1.49), tobacco (OR 1.22; 95% CI 1.04 to 1.44) and illicit drug consumption during pregnancy and risk of neuroblastoma during childhood, with illicit drug consumption showing the strongest association (OR 3.26; 95% CI 1.36 to 7.86). However, adjusted estimates were highly heterogeneous.

LIMITATIONS

All studies were at high risk of bias.

CONCLUSIONS

Smoking, alcohol or illicit drugs during pregnancy might play a role in the development of neuroblastoma. However, well-designed studies are needed to assess whether these exposures are causal and whether time period during pregnancy, dose or co-consumption of substances is critical.

TRIAL REGISTRATION NUMBER

Registration number CRD42016036165.

Maternal Residential Proximity to Major Roadways and Pediatric Embryonal Tumors in Offspring

The environmental determinants of pediatric embryonal tumors remain unclear. Because of the growing concern over the impact of exposures to traffic-related air pollution on pediatric cancer, we conducted a population-based study evaluating the impact of maternal residential proximity to major roadways on the risk of pediatric embryonal tumors in offspring. We identified children diagnosed with neuroblastoma, Wilms tumor, retinoblastoma, or hepatoblastoma at <5 years of age from the Texas Cancer Registry and selected unaffected controls from birth certificates. Two residential proximity measures were used: (1) distance to the nearest major roadway, and (2) within 500 m of a major roadway. Logistic regression was used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) for each proximity measure on pediatric embryonal tumors. The odds of an embryonal tumor were increased in children born to mothers living within 500 m of a major roadway (aOR = 1.24, 95% CI: 1.00, 1.54). This was consistent for most tumor subtypes, with the strongest associations observed for unilateral retinoblastoma (aOR = 2.57, 95% CI: 1.28, 5.15, for every kilometer closer the mother lived to the nearest major roadway). These findings contribute to the growing evidence that traffic-related air pollution may increase risk for certain pediatric tumors.

Metastatic neuroblastoma diagnosed on prenatal sonographic examination performed for decreased fetal movement

We report a case of fetal neuroblastoma presenting with massive liver metastasis diagnosed during the biophysical profile sonographic examination performed for decreased fetal movement. The patient presented at 37 weeks' gestation with limited fetal movement over 24 hours. Biophysical profile showed marked polyhydramnios and an enlarged abdomen filled with a homogeneous mass lesion suspicious for liver metastasis. Primary urgent cesarean section was performed revealing a cachectic neonate with a rigid and grossly distended abdomen. Neonatal evaluation confirmed the etiology of the abdominal mass to be liver metastasis from neuroblastoma. The child died on the 46th day. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:502-506, 2017.

Pediatric cancer risk in association with birth defects: A systematic review

BACKGROUND

Many epidemiological studies have examined associations between birth defects (BDs) and pediatric malignancy over the past several decades. Our objective was to conduct a systematic literature review of studies reporting on this association.

METHODS

We used librarian-designed searches of the PubMed Medline and Embase databases to identify primary research articles on pediatric neoplasms and BDs. English language articles from PubMed and Embase up to 10/12/2015, and in PubMed up to 5/12/2017 following an updated search, were eligible for inclusion if they reported primary epidemiological research results on associations between BDs and pediatric malignancies. Two reviewers coded each article based on the title and abstract to identify eligible articles that were abstracted using a structured form. Additional articles were identified through reference lists and other sources. Results were synthesized for pediatric cancers overall and for nine major pediatric cancer subtypes.

RESULTS

A total of 14,778 article citations were identified, of which 80 met inclusion criteria. Pediatric cancer risk was increased in most studies in association with BDs overall with some notable specific findings, including increased risks for CNS tumors in association with CNS abnormalities and positive associations between rib anomalies and several pediatric cancer types.

CONCLUSIONS

Some children born with BDs may be at increased risk for specific pediatric malignancy types. This work provides a foundation for future investigations that are needed to clarify specific BD types predisposing toward malignancy and possible underlying causes of both BDs and malignancy.

Maternal Preeclampsia and Odds of Childhood Cancers in Offspring: A California Statewide Case-Control Study

BACKGROUND

Preeclampsia is a major cause of adverse effects on fetal health. We examined associations between fetal exposure to preeclampsia and subsequent odds of childhood cancers.

METHODS

We obtained childhood cancer cases (n = 13 669) diagnosed at 5 years old or younger between 1988 and 2012 from the California Cancer Registry and linked them to birth certificates. Controls (n = 271 383) were randomly selected from all California births and frequency matched to cases by birth year. We obtained data regarding preeclampsia during pregnancy, labour, and delivery from the medical worksheet of the electronic birth record. We used unconditional logistic regression models with stabilised inverse probability weights to estimate the effect of preeclampsia on each subtype of childhood cancer, taking into account potential confounding by pregnancy characteristics. Marginal structural models were fitted to assess the controlled direct effects of preeclampsia, independent of preterm delivery and NICU admission.

RESULTS

Although a null association was observed for all cancer subtypes combined (odds ratio (OR) 1.0, 95% confidence interval (CI) 0.9, 1.2), preeclampsia was found to be associated with increased odds of two histological subtypes of germ cell tumours: seminomas (OR 8.6, 95% CI 1.9, 38.4) and teratoma (OR 3.0, 95% CI 1.7, 5.4), but not yolk sac tumours in children. Odds remained elevated after adjusting for preterm delivery and NICU admission. Increases in odds were also observed for hepatoblastoma, however this association was attenuated in marginal structural models after accounting for NICU admission.

CONCLUSIONS

These findings suggest that maternal preeclampsia is associated with higher odds of some rare childhood cancers and may shed light on new aetiological factors for these cancers.

Neuroblastoma (Peripheral neuroblastic tumours)

Peripheral neuroblastic tumours (PNTs), a family of tumours arising in the embryonal remnants of the sympathetic nervous system, account for 7-10% of all tumours in children. In two-thirds of cases, PNTs originate in the adrenal glands or the retroperitoneal ganglia. At least one third present metastases at onset, with bone and bone marrow being the most frequent metastatic sites. Disease extension, MYCN oncogene status and age are the most relevant prognostic factors, and their influence on outcome have been considered in the design of the recent treatment protocols. Consequently, the probability of cure has increased significantly in the last two decades. In children with localised operable disease, surgical resection alone is usually a sufficient treatment, with 3-year event-free survival (EFS) being greater than 85%. For locally advanced disease, primary chemotherapy followed by surgery and/or radiotherapy yields an EFS of around 75%. The greatest problem is posed by children with metastatic disease or amplified MYCN gene, who continue to do badly despite intensive treatments. Ongoing trials are exploring the efficacy of new drugs and novel immunological approaches in order to save a greater number of these patients.

Temporal clustering of neuroblastic tumours in children and young adults from Northern England

BACKGROUND

The aetiology of neuroblastic tumours is unclear with both genetic and environmental factors implicated. The possibility that an infectious agent may be involved has been suggested. 'Temporal clustering' occurs if cases display an irregular temporal distribution and may indicate the involvement of an agent that exhibits epidemicity. We tested for the presence and nature of temporal clustering using population-based data from northern England.

METHODS

We extracted all cases of neuroblastic tumours diagnosed in children and young adults aged 0-24 years during 1968-2011 from the Northern Region Young Persons' Malignant Disease Registry. This is a population-based registry, covering a population of approximately 900,000 young persons, and includes all cases resident in northern England at the time of diagnosis. Tests for temporal clustering were applied using a modified version of the Potthoff-Whittinghill method. Estimates of extra-Poisson variation (β) and standard errors (SEs) were obtained.

RESULTS

227 cases of neuroblastic tumours were diagnosed during the study period. All the analyses between fortnights and between months found significant extra-Poisson variation, with β = 0.846 (SE = 0.310, P = 0.004) for the analysis between fortnights within months. Restricting the analyses to the 76 cases diagnosed at ages less than 18 months showed significant extra-Poisson variation between fortnights within months (β = 1.532, SE = 0.866, P = 0.038), but not between months. In contrast, analyses of cases aged 18 months to 24 years showed significant extra-Poisson variation between quarters within years, as well as over shorter timescales.

CONCLUSIONS

Transient environmental agents may be involved in the aetiology of neuroblastic tumours. The initiating factor might be a geographically-widespread agent that occurs in 'mini-epidemics'.

Fetal alcohol spectrum disorders and childhood cancer: a concise review of case reports and future research considerations

We reviewed the published literature on the relationship between childhood cancer and fetal alcohol spectrum disorders (FASD). A Pub Med search identified 12 subjects with the co-occurrence of FASD and cancer. We included an additional case from the author's institution. Neuroblastomas comprised 6 of the 13 (46%) case reports, yet neuroblastomas comprise only about 10% of childhood cancers (z = 4.1; P < 0.001). Other than rhabdomyosarcoma, no other cancer was reported more than once. Few cases of childhood cancer associated with FASD were identified likely due to under ascertainment of FASD.

Maternal and perinatal risk factors for childhood cancer: record linkage study

OBJECTIVE

To investigate maternal and perinatal risk factors for childhood cancer.

STUDY DESIGN

Case-control analysis of linked records from the Aberdeen Maternity and Neonatal Databank with the Scottish Cancer Registry and the General Registry of Births and Deaths in Scotland was carried out.

SETTING

Aberdeen, Scotland.

PARTICIPANTS

Cases (n=176) comprised children diagnosed with cancer under 15 years or recorded as having died of cancer. Four controls per case were matched by age and gender.

RISK FACTORS TESTED

Maternal age, body mass index, social class, marital status and smoking as well as pre-eclampsia, antepartum haemorrhage and previous miscarriage, gestational age, birth weight and Apgar scores were compared between groups to test for association with cancer. ORs with 95% CIs were calculated using conditional logistic regression in univariable and multivariable models.

RESULTS

Of the maternal characteristics tested, mother's age at delivery (cases mean 28.9 (SD 5.6) years vs controls mean 30.2 (SD 4.6), p=0.002) and smoking status (38.6% smokers among cases, 29.7% among controls, p=0.034) were found to be different between groups. Of the perinatal factors tested, low Apgar score at 5 min (adjusted OR (AOR) 4.59, 95% CI 1.52 to 13.87) and delivery by caesarean section (AOR 1.95, 95% CI 1.30 to 2.92) showed statistically significant associations with childhood cancer in the multivariable model.

CONCLUSIONS

Younger maternal age, maternal smoking, delivery by caesarean section and low Apgar score at 5 min were independently associated with increased risk of childhood cancer. These general findings should be interpreted with caution as this study did not have the power to detect any association with individual diagnostic categories of childhood cancer.

Association of maternal education with the neuroblastoma susceptibility in children: a meta-analysis

Maternal education might be an important factor for the neuroblastoma risk in children, but it was conflicting. This meta-analysis was performed to evaluate the relationship between maternal education and neuroblastoma susceptibility and to explore whether maternal education was an important indicator to be associated with the neuroblastoma risk in children. The association studies were identified from the databases of PubMed, and Cochrane Library as of June 1, 2012, and eligible investigations were synthesized using meta-analysis method. Results were expressed with odds ratios (OR) for dichotomous data, and 95% confidence intervals (CI) were also calculated. Six literatures were identified for the analysis of association between maternal education and neuroblastoma susceptibility in children, consisting of 2063 patients with cancer and 13,925 controls. There was no a marked association between maternal education and neuroblastoma susceptibility when the maternal education was less than high school (OR = 0.66, 95% CI: 0.43-1.01, P = .06). We also found that maternal education was not associated with the neuroblastoma susceptibility when the maternal education was high school (OR = 0.74, 95% CI: 0.31-1.75, P = .49) and more than high school (OR = 0.78, 95% CI: 0.33-1.85, P = .58). In conclusion, maternal education is not associated with the neuroblastoma susceptibility in children. However, more investigations are required to further clarify the association of maternal education with the neuroblastoma susceptibility in children.

Neuroblastoma presented with polyhydramniosis

Neuroblastoma is the most common extracranial solid tumor in pediatric age group. Clinical presentation of neuroblastoma is mostly related to origin of the tumor, extent of disease, and the presence of paraneoplastic syndromes. Here the authors report a neonate with neuroblastoma with an atypical presentation, diagnosed with postnatal abdominal ultrasonography performed due to polyhydramniosis in her mother during pregnancy.

Birth weight and risk of neuroblastoma: a meta-analysis

BACKGROUND

Neuroblastoma is the most common solid tumour in infancy but its aetiology is largely unknown. Prenatal factors might play a key role in its pathogenesis. Previous studies investigated whether birth weight is associated with risk of neuroblastoma, with conflictive results. We conducted a meta-analysis to quantitatively summarize the published evidence.

METHODS

Results from 10 case-control studies and one cohort study (1966 to December 2008) were included, involving a total of 3004 children with neuroblastoma. We constructed random-effects and fixed-effects models, performed 'pool-first' analyses, assessed heterogeneity and publication bias and performed sensitivity and influence analyses.

RESULTS

High birth weight (>4000 g) was associated with increased risk of neuroblastoma [odds ratio (OR) 1.19; 95% confidence interval (CI) 1.04-1.36]. Results for high birth weight were highly homogenous (I(2) = 0%). Low birth weight (<2500 g) was also related to increased risk of neuroblastoma (OR 1.24; 95% CI 1.0-1.55), but results were more heterogeneous (I(2 )= 30%). No evidence for particularly influential studies or for publication bias was found. However, sensitivity analysis indicated the presence of bias in studies on the association with low birth weight. Above 2500 g each 1000-g increase in birth weight was associated with a 13% (95% CI 3-25) increase in risk of neuroblastoma.

CONCLUSIONS

This meta-analysis shows that high birth weight is highly reproducibly associated with increased risk of neuroblastoma. The association with low birth weight was found to be less robust and deserves further studies.

Birth and parental characteristics and risk of neuroblastoma in a population-based Norwegian cohort study

In this population-based Norwegian cohort study (2.1 million children), the impact of birth and parental characteristics on the risk of neuroblastoma (178 cases) was evaluated. In children below the age of 18 months, there was an increased neuroblastoma risk among those with congenital malformations and suggestion of increased risk when the mother had pre-eclampsia.