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Jung EM, Johnson RA, Hubbard AK, Spector LG. Exploration of genetic ancestry and socioeconomic status in the incidence of neuroblastoma: An ecological study. Pediatr Blood Cancer 2022; 69:e29571. [PMID: 35107882 DOI: 10.1002/pbc.29571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Abstract
Although global differences in the incidence of neuroblastoma have been examined, the underlying mechanism has yet to be elucidated. Previous studies have suggested genetic ancestry and human development index (HDI) as contributing factors, but few studies have been conducted at the international level. Here, we aimed to examine whether the frequency of common genomic variation associated with neuroblastoma can affect its risk at the ecological level with consideration of the HDI. Minor allele frequencies (MAFs) for 22 single-nucleotide polymorphisms (SNPs) were abstracted from the Geography of Genetic Variants Browser. The number of incident neuroblastomas for each population was obtained from the Cancer Incidence in Five Continents series. Further, population pseudo-polygenic risk scores (pp-PRSs) were calculated as a sum of MAFs at the population level, each of which was weighted by effect sizes from prior studies. Negative binomial regression was used to estimate the incidence rate ratios (IRRs) and the 95% confidence intervals (CIs) to examine whether differences in MAFs across the population influence the risk of neuroblastoma, with and without adjustment for HDI and whether pp-PRSs can be a predictor of the risk of neuroblastoma. Overall, our results indicated that the neuroblastoma risk associated with variation in SNP frequency could not be differentiated from that of HDI at the ecological level. Additionally, pp-PRSs were not significantly associated with the risk of neuroblastoma (IRR: 0.99, 95% CI: 0.62-1.60). Further study using individual-level data is warranted to minimize the bias related to the use of population-level data in this study.
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Affiliation(s)
- Eun Mi Jung
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca A Johnson
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aubrey K Hubbard
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Logan G Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
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2
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Mattosinho C, Moura AT, Grigorovski N, Araújo LH, Ferman S, Ribeiro K. Socioeconomic status and retinoblastoma survival: Experience of a tertiary cancer center in Brazil. Pediatr Blood Cancer 2021; 68:e28757. [PMID: 33089657 DOI: 10.1002/pbc.28757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Little is known about socioeconomic status (SES) and its effects in childhood cancer survival. This study aims to discuss the association between SES and survival of patients with retinoblastoma (RB) from a tertiary treatment center. PROCEDURE A retrospective cohort study was conducted, including all patients with RB referred to the Brazilian National Institute of Cancer in Rio de Janeiro (January 2000-December 2016). RESULTS Data from 160 patients were analyzed with mean age at diagnosis of 22.85 months (SD ± 14.29). Eighty-three patients (51.9%) had an interval to diagnosis equal to or longer than six months, and 13 children (8.1%) abandoned treatment. Five-year overall survival rate for all patients was 78.8% (95% CI, 72.4%-85.9%). In a multivariate model, patients whose fathers had more than nine years of study had a lower death risk. Patients from families having more than one child under five years had a 213% higher risk of death compared with those living with no other small child. Treatment abandonment also had a profound effect on death risk. CONCLUSION Childhood cancer is notably important considering the potential years of life lost. RB has even more important elements, as the possibility of vision loss in cases with delayed diagnosis. Family characteristics seem to be highly related to RB survival, especially in low- and middle-income countries, where inequalities are still a public health issue. Strategies to improve survival should focus not only on large-scale settings such as improving national healthcare systems but also on more personalized actions that might help to mitigate disparities.
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Affiliation(s)
- Clarissa Mattosinho
- Department of Ocular Oncology, Division of Surgery, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Anna Tereza Moura
- Department of Pediatrics, Faculdade de Medicina, Pós Graduação em Ciências Médicas da Universidade do Estado do, Rio de Janeiro, Brazil
| | - Nathalia Grigorovski
- Department of Pediatric Oncology, Clinical Division, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Luiz Henrique Araújo
- Division of Clinical Research, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Sima Ferman
- Department of Pediatric Oncology, Clinical Division, National Institute of Cancer, Rio de Janeiro, Brazil
| | - Karina Ribeiro
- Department of Collective Health (Associate Professor), Faculdade de Ciências Médicas da Santa Casa, São Paulo, Brazil
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van Heerden J, Kruger M. Management of neuroblastoma in limited-resource settings. World J Clin Oncol 2020; 11:629-643. [PMID: 32879849 PMCID: PMC7443833 DOI: 10.5306/wjco.v11.i8.629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/23/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuroblastoma (NB) is a heterogeneous disease with variable outcomes among countries. Little is known about NB in low- and middle-income countries (LMICs).
AIM The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries (HICs).
METHODS PubMed, Global Health, Embase, SciELO, African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB, LMICs and outcomes. Only English language manuscripts and abstracts were included. A descriptive review was done, and tables illustrating the findings were constructed.
RESULTS Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available. The disease characteristics varied among countries for the following variables: sex, age at presentation, MYCN amplification, stage and outcome. LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs. Implementation of evidence-based treatment protocols was still a barrier to care. Many socioeconomic variables also influenced the diagnosis, management and follow-up of patients with NB.
CONCLUSION Patients presented at a later age with more advanced disease in LMICs. Management was limited by the lack of resources and genetic studies for improved NB classification. Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources.
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Affiliation(s)
- Jaques van Heerden
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
- Department of Paediatric Haematology and Oncology, Antwerp University Hospital, Edegem 2650, Belgium
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
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Santiago T, Tarek N, Boulos F, Hayes C, Jeha S, Raimondi S, Rodriguez-Galindo C. Correlation Between MYCN Gene Status and MYCN Protein Expression in Neuroblastoma: A Pilot Study To Propose the Use of MYCN Immunohistochemistry in Limited-Resource Areas. J Glob Oncol 2020; 5:1-7. [PMID: 31365300 PMCID: PMC6690657 DOI: 10.1200/jgo.19.00135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The most significant adverse risk factor for neuroblastoma (NB) is MYCN gene amplification, which strongly associates with high-risk disease. Fluorescent in situ hybridization (FISH) is considered the best method to evaluate MYCN gene status. However, it requires a laboratory that can perform highly complex testing, specialized personnel, and costly reagents. Herein, we aimed to investigate the feasibility of using immunohistochemistry (IHC) to detect MYCN protein expression in lieu of FISH, a strategy potentially useful in areas with limited resources. METHODS A pilot cohort of 78 patients with NB, including 34 of Middle Eastern descent (MED) who had a higher prevalence of MYCN gene amplification (44.11%) and 44 of North American descent (NAD), nine (20.45%) of whom had MYCN amplification, was evaluated with IHC for MYCN protein. Correlations of FISH results and protein expression are presented. RESULTS A positive correlation between MYCN gene amplification and protein expression by IHC was seen in 22 (91.66%) of the 24 MYCN-amplified NB cases—14 (93.33%) of 15 patients of MED and eight (88.88%) of nine patients of NAD. Agreement between negative FISH and negative IHC results was noted in 18 (94.73%) patients of MED and 34 (97.14%) patients of NAD. Two cases had weak protein expression but no gene amplification (MED: n = 1; 5.0%; NAD: n = 1; 2.9%). CONCLUSION An excellent overall correlation between MYCN gene status by FISH and MYCN protein expression by IHC was confirmed. MYCN IHC in NB with reflexing to FISH in equivocal cases is potentially useful in a limited-resource setting. Evaluation of effectiveness using a larger cohort and optimization to perform MYCN IHC manually is needed.
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Affiliation(s)
| | - Nidale Tarek
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Boulos
- St Jude Children's Research Hospital, Memphis, TN
| | - Caleb Hayes
- St Jude Children's Research Hospital, Memphis, TN
| | - Sima Jeha
- St Jude Children's Research Hospital, Memphis, TN
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Koshy A, Jain R, Srinivasan R, Bhatia P, Kakkar N, Rajwanshi A, Gupta N, Dey P, Trehan A, Bansal D. Cytopathological spectrum of peripheral neuroblastic tumours in fine needle aspiration cytology and categorisation as per International Neuroblastoma Pathology Classification. Cytopathology 2019; 30:634-643. [DOI: 10.1111/cyt.12747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/01/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Abin Koshy
- Department of Cytology and Gynecological PathologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Richa Jain
- Hemato‐Oncology UnitDepartment of PediatricsPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological PathologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Prateek Bhatia
- Hemato‐Oncology UnitDepartment of PediatricsPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Nandita Kakkar
- Department of HistopathologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological PathologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Nalini Gupta
- Department of Cytology and Gynecological PathologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Pranab Dey
- Department of Cytology and Gynecological PathologyPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Amita Trehan
- Hemato‐Oncology UnitDepartment of PediatricsPostgraduate Institute of Medical Education and Research Chandigarh India
| | - Deepak Bansal
- Hemato‐Oncology UnitDepartment of PediatricsPostgraduate Institute of Medical Education and Research Chandigarh India
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Rong X, Sun C, Zhang F, Zheng J. Effect of dexmedetomidine anesthesia on respiratory function in pediatric patients undergoing retinoblastoma resection. Oncol Lett 2019; 17:2721-2728. [PMID: 30867730 PMCID: PMC6365899 DOI: 10.3892/ol.2019.9893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to investigate the effect of dexmedetomidine (Dex) on the respiratory function during anesthesia induction in pediatric patients undergoing retinoblastoma (RB) resection. A total of 87 pediatric patients who underwent RB resection in Yidu Central Hospital of Weifang were recruited into this study. General anesthesia was first induced for all patients, of which 45 were randomly assigned to the experimental group and received Dex through an intravenous infusion pump to maintain general anesthesia. The remaining 42 patients were assigned to the control group and received saline through an intravenous infusion pump. Respiratory function and hemodynamic indexes at five time-points, i.e., before anesthesia induction (T0), 5 min after injection of anesthetic agents (T1), before intubation (T2), 15 min after intubation (T3), and 30 min after extubation (T4), were recorded and compared. Incidence of perioperative cardiac and respiratory adverse events was counted in both groups, and post-anesthesia resuscitation was evaluated and compared. Compared with T0, the respiratory rate (R) of the experimental group was lower at T1-T4, but there was no statistical difference (P<0.05). Compared with T0, the control group had a higher R at T2, lower R at T3 and T4 (P<0.05), and there was no significant difference in R between T0 and T1 (P>0.05). At the same time-point, compared with the experimental group, the R was higher at T2, and lower at T3 and T4 in the control group (P<0.05), and no significant difference was found at T1. Blood oxygen saturation (SpO2) of the experimental group was slightly lower than that of T0 at T1-T4 (P>0.05). In the control group, the levels of SpO2 were significantly lower at T1-T4 than those at T0 (P<0.05). Compared with the experimental group at the same time-point, SpO2 of the control group at T1-T4 decreased significantly (P<0.05). The heart rate (HR) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). The HR of the experimental group was higher than that of the control group at T1-T4 (P<0.05). Mean arterial pressure (MAP) of the experimental and control groups was lower at T1-T4 than that at T0 (P<0.05). MAP of the control group was higher than that of the experimental group at T2 but lower than that at T0 of the control group. MAP of the control group was lower than that of the experimental group at T1-T4. There was no significant difference in incidence of tachycardia, bradycardia, vomiting, hypoxia and laryngism between the two groups (P>0.05). There was no difference in resuscitation and extubation time between the two groups (P>0.05). Finally, agitation of the control group was more severe than that of the experimental group (P<0.05). Therefore, Dex can improve the respiratory function and hemodynamic stability during anesthesia induction in children with RB resection.
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Affiliation(s)
- Xi Rong
- School of Pharmacy of Qingdao University, Qingdao, Shandong 266021, P.R. China.,Department of Pharmacy, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Chunlei Sun
- Department of Pediatric Internal Medicine, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Feng Zhang
- Department of Pharmacy, Yidu Central Hospital of Weifang, Weifang, Shandong 262500, P.R. China
| | - Jie Zheng
- School of Pharmacy of Qingdao University, Qingdao, Shandong 266021, P.R. China
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7
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Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, Steliarova-Foucher E, Frazier AL, Robison LL, Rodriguez-Galindo C, Fitzmaurice C. Childhood cancer burden: a review of global estimates. Lancet Oncol 2019; 20:e42-e53. [PMID: 30614477 DOI: 10.1016/s1470-2045(18)30761-7] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 12/18/2022]
Abstract
5-year net survival of children and adolescents diagnosed with cancer is approximately 80% in many high-income countries. This estimate is encouraging as it shows the substantial progress that has been made in the diagnosis and treatment of childhood cancer. Unfortunately, scarce data are available for low-income and middle-income countries (LMICs), where nearly 90% of children with cancer reside, suggesting that global survival estimates are substantially worse in these regions. As LMICs are undergoing a rapid epidemiological transition, with a shifting burden from infectious diseases to non-communicable diseases, cancer care for all ages has become a global focus. To improve outcomes for children and adolescents diagnosed with cancer worldwide, an accurate appraisal of the global burden of childhood cancer is a necessary first step. In this Review, we analyse four studies of the global cancer burden that included data for children and adolescents. Each study used various overlapping and non-overlapping statistical approaches and outcome metrics. Moreover, to provide guidance on improving future estimates of the childhood global cancer burden, we propose several recommendations to strengthen data collection and standardise analyses. Ultimately, these data could help stakeholders to develop plans for national and institutional cancer programmes, with the overall aim of helping to reduce the global burden of cancer in children and adolescents.
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Affiliation(s)
- Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Lisa M Force
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rifat Atun
- Harvard T H Chan School of Public Health and Harvard Medical School, Harvard University, Boston, MA, USA
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Christina Fitzmaurice
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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8
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Yen CM, Tsai CW, Chang WS, Yang YC, Hung YW, Lee HT, Shen CC, Sheu ML, Wang JY, Gong CL, Cheng WY, Bau DAT. Novel Combination of Arsenic Trioxide (As 2O 3) Plus Resveratrol in Inducing Programmed Cell Death of Human Neuroblastoma SK-N-SH Cells. Cancer Genomics Proteomics 2018; 15:453-460. [PMID: 30343279 DOI: 10.21873/cgp.20104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/23/2022] Open
Abstract
AIM Arsenic trioxide (As2O3), known as pi-shuang and the most toxic compound in traditional Chinese medicine, has been used as an antitumor agent for thousands of years. Resveratrol (3,5,4'-trihydroxy-trans-stilbene) is a natural phenol that has significant anti-bacterial, anti-fungaI and antiaging activities. Our study aimed to examine the combined anticancer effects of As2O3 and resveratrol against human neuroblastoma SK-N-SH cells, and elucidate the underlying intracellular signaling. MATERIALS AND METHODS SK-N-SH cells were treated with an extremely low-dose (2-4 μM) of As2O3 alone or combined with 75 μg/ml resveratrol for further comparisons. Cell viability, apoptotic signaling as well as synergistic cytotoxic effects were estimated using the MTT assay, microscopy observation, flow cytometric analysis for loss of mitochondrial membrane potential (MMP) and reactive oxygen species (ROS), and typical quantitative western blotting analysis. Student's t-test, and one- and two-way analysis of variance (ANOVA) were used for examination of significant differences. RESULTS The combined treatment was more effective than single treatment of As2O3 or resveratrol alone in suppressing cell viability, which correlated with the elevation of ROS levels. The intracellular mechanisms of cytotoxicity of As2O3 plus resveratrol were revealed as ROS accumulation and relative decrease of MMP, leading to activation of caspase-3 and -9, but not of caspase-1, -7 and-8. Combination treatment reduced the expression of B-cell lymphoma 2 (BCL2), BH3 interacting domain death agonist (BID), and BCL-x/L. CONCLUSION Combined treatment at extremely low concentration of two agents from natural products, As2O3 and resveratrol, has high potential as a cocktail of anticancer drugs for neuroblastoma.
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Affiliation(s)
- Chun-Ming Yen
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C.,Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Chia-Wen Tsai
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Wen-Shin Chang
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Yi-Chin Yang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Yi-Wen Hung
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Hsu-Tung Lee
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Chiung-Chyi Shen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Meei-Ling Sheu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, R.O.C
| | - Ju-Yu Wang
- Basic Medical Science, Department of Nursing, Hung Kuang University, Taichung, Taiwan, R.O.C
| | - Chi-Li Gong
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan, R.O.C.
| | - Wen-Yu Cheng
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. .,Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan, R.O.C
| | - DA-Tian Bau
- Terry Fox Cancer Research Laboratory, Translational Medicine Research Center, China Medical University Hospital, Taichung, Taiwan, R.O.C. .,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, R.O.C
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9
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Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care. CHILDREN-BASEL 2018; 5:children5110143. [PMID: 30360527 PMCID: PMC6262277 DOI: 10.3390/children5110143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/13/2022]
Abstract
International disparities in outcomes from pediatric solid tumors remain striking. Herein, we review the current literature regarding management, outcomes, and barriers to care for pediatric solid tumors in low- and middle-income countries (LMICs). In sub-Saharan Africa, Wilms Tumor represents the most commonly encountered solid tumor of childhood and has been the primary target of recent efforts to improve outcomes in low-resource settings. Aggressive and treatment-resistant tumor biology may play a role in poor outcomes within certain populations, but socioeconomic barriers remain the principal drivers of preventable mortality. Management protocols that include measures to address socioeconomic barriers have demonstrated early success in reducing abandonment of therapy. Further work is required to improve infrastructure and general pediatric care to address disparities.
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10
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Doganis D, Panagopoulou P, Tragiannidis A, Georgakis MK, Moschovi M, Polychronopoulou S, Rigatou E, Papakonstantinou E, Stiakaki E, Dana H, Bouka E, Antunes L, Bastos J, Coza D, Demetriou A, Agius D, Eser S, Ryzhov A, Sekerija M, Trojanowski M, Zagar T, Zborovskaya A, Perisic SZ, Stefanaki K, Dessypris N, Petridou ET. Childhood nephroblastoma in Southern and Eastern Europe and the US: Incidence variations and temporal trends by human development index. Cancer Epidemiol 2018; 54:75-81. [PMID: 29655086 DOI: 10.1016/j.canep.2018.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/22/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
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Kehm RD, Spector LG, Poynter JN, Vock DM, Osypuk TL. Socioeconomic Status and Childhood Cancer Incidence: A Population-Based Multilevel Analysis. Am J Epidemiol 2018; 187:982-991. [PMID: 29036606 DOI: 10.1093/aje/kwx322] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022] Open
Abstract
The etiology of childhood cancers remains largely unknown, especially regarding environmental and behavioral risk factors. Unpacking the association between socioeconomic status (SES) and incidence may offer insight into such etiology. We tested associations between SES and childhood cancer incidence in a population-based case-cohort study (source cohort: Minnesota birth registry, 1989-2014). Cases, ages 0-14 years, were linked from the Minnesota Cancer Surveillance System to birth records through probabilistic record linkage. Controls were 4:1 frequency matched on birth year (2,947 cases and 11,907 controls). We tested associations of individual-level (maternal education) and neighborhood-level (census tract composite index) SES using logistic mixed models. In crude models, maternal education was positively associated with incidence of acute lymphoblastic leukemia (odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.02, 1.19), central nervous system tumors (OR = 1.12, 95% CI: 1.04, 1.21), and neuroblastoma (OR = 1.15, 95% CI: 1.02, 1.30). Adjustment for established risk factors-including race/ethnicity, maternal age, and birth weight-substantially attenuated these positive associations. Similar patterns were observed for neighborhood-level SES. Conversely, higher maternal education was inversely associated with hepatoblastoma incidence (adjusted OR = 0.70, 95% CI: 0.51, 0.98). Overall, beyond the social patterning of established demographic and pregnancy-related exposures, SES is not strongly associated with childhood cancer incidence.
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Affiliation(s)
- Rebecca D Kehm
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Logan G Spector
- University of Minnesota, Division of Epidemiology and Clinical Research, Department of Pediatrics, Minneapolis, Minnesota
| | - Jenny N Poynter
- University of Minnesota, Division of Epidemiology and Clinical Research, Department of Pediatrics, Minneapolis, Minnesota
| | - David M Vock
- University of Minnesota School of Public Health, Division of Biostatistics, Minneapolis, Minnesota
| | - Theresa L Osypuk
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
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12
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Panagopoulou P, Georgakis MK, Baka M, Moschovi M, Papadakis V, Polychronopoulou S, Kourti M, Hatzipantelis E, Stiakaki E, Dana H, Tragiannidis A, Bouka E, Antunes L, Bastos J, Coza D, Demetriou A, Agius D, Eser S, Gheorghiu R, Šekerija M, Trojanowski M, Žagar T, Zborovskaya A, Ryzhov A, Dessypris N, Morgenstern D, Petridou ET. Persisting inequalities in survival patterns of childhood neuroblastoma in Southern and Eastern Europe and the effect of socio-economic development compared with those of the US. Eur J Cancer 2018; 96:44-53. [PMID: 29673989 DOI: 10.1016/j.ejca.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 01/13/2023]
Abstract
AIM Neuroblastoma outcomes vary with disease characteristics, healthcare delivery and socio-economic indicators. We assessed survival patterns and prognostic factors for patients with neuroblastoma in 11 Southern and Eastern European (SEE) countries versus those in the US, including-for the first time-the Nationwide Registry for Childhood Hematological Malignancies and Solid Tumours (NARECHEM-ST)/Greece. METHODS Overall survival (OS) was calculated in 13 collaborating SEE childhood cancer registries (1829 cases, ∼1990-2016) and Surveillance, Epidemiology, and End Results (SEER), US (3072 cases, 1990-2012); Kaplan-Meier curves were used along with multivariable Cox regression models assessing the effect of age, gender, primary tumour site, histology, Human Development Index (HDI) and place of residence (urban/rural) on survival. RESULTS The 5-year OS rates varied widely among the SEE countries (Ukraine: 45%, Poland: 81%) with the overall SEE rate (59%) being significantly lower than in SEER (77%; p < 0.001). In the common registration period within SEE (2000-2008), no temporal trend was noted as opposed to a significant increase in SEER. Age >12 months (hazard ratio [HR]: 2.8-4.7 in subsequent age groups), male gender (HR: 1.1), residence in rural areas (HR: 1.3), living in high (HR: 2.2) or medium (HR: 2.4) HDI countries and specific primary tumour location were associated with worse outcome; conversely, ganglioneuroblastoma subtype (HR: 0.28) was associated with higher survival rate. CONCLUSIONS Allowing for the disease profile, children with neuroblastoma in SEE, especially those in rural areas and lower HDI countries, fare worse than patients in the US, mainly during the early years after diagnosis; this may be attributed to presumably modifiable socio-economic and healthcare system performance differentials warranting further research.
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Affiliation(s)
- Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Marios K Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Margarita Baka
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece
| | - Emmanuel Hatzipantelis
- Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Greece
| | - Helen Dana
- Pediatric Hematology-Oncology Department, "Mitera" Children's Hospital, Athens, Greece
| | - Athanasios Tragiannidis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology, Porto, Portugal
| | - Joana Bastos
- Registo Oncológico Regional do Centro (ROR-Centro), Portuguese Institute of Oncology, Coimbra, Portugal
| | - Daniela Coza
- The Oncology Institute "Prof. Dr. Ion Chiricuţă", Cluj-Napoca, Romania
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department for Policy in Health - Health Information and Research, Pieta, Malta
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe, University Institute of Public Health, Ankara, Turkey
| | - Raluca Gheorghiu
- Regional Cancer Registry, National Institute of Public Health, Iasi, Romania
| | - Mario Šekerija
- Croatian Institute of Public Health, Croatian National Cancer Registry, Zagreb, Croatia; Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznań, Poland
| | - Tina Žagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Anna Zborovskaya
- Belarusian Research Center for Paediatric Oncology, Haematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Kiev, Ukraine
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Daniel Morgenstern
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School, National and Kapodistrian University of Athens, Athens Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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13
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Scheurer ME, Lupo PJ, Schüz J, Spector LG, Wiemels JL, Aplenc R, Gramatges MM, Schiffman JD, Pombo-de-Oliveira MS, Yang JJ, Heck JE, Metayer C, Orjuela-Grimm MA, Bona K, Aristizabal P, Austin MT, Rabin KR, Russell HV, Poplack DG. An overview of disparities in childhood cancer: Report on the Inaugural Symposium on Childhood Cancer Health Disparities, Houston, Texas, 2016. Pediatr Hematol Oncol 2018; 35:95-110. [PMID: 29737912 PMCID: PMC6685736 DOI: 10.1080/08880018.2018.1464088] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Inaugural Symposium on Childhood Cancer Health Disparities was held in Houston, Texas, on November 2, 2016. The symposium was attended by 109 scientists and clinicians from diverse disciplinary backgrounds with interests in pediatric cancer disparities and focused on reviewing our current knowledge of disparities in cancer risk and outcomes for select childhood cancers. Following a full day of topical sessions, everyone participated in a brainstorming session to develop a working strategy for the continued expansion of research in this area. This meeting was designed to serve as a springboard for examination of childhood cancer disparities from a more unified and systematic approach and to enhance awareness of this area of need.
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Affiliation(s)
- Michael E Scheurer
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Philip J Lupo
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Joachim Schüz
- c Section of Environment and Radiation , International Agency for Research on Cancer , Lyon , France
| | - Logan G Spector
- d Division of Epidemiology and Clinical Research, Department of Pediatrics , University of Minnesota , Minneapolis , MN , USA
| | - Joseph L Wiemels
- e Department of Preventative Medicine , University of Southern California , Los Angeles , CA , USA
| | - Richard Aplenc
- f Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - M Monica Gramatges
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Joshua D Schiffman
- g Department of Pediatrics and Department of Oncological Sciences , Huntsman Cancer Institute, University of Utah , Salt Lake City , UT , USA
| | - Maria S Pombo-de-Oliveira
- h Programa de Hematologia-Oncologia Pediátrico , Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | - Jun J Yang
- i Department of Pharmaceutical Sciences , St Jude Children's Research Hospital , Memphis , TN , USA
| | - Julia E Heck
- j Department of Epidemiology , University of California Los Angeles , Los Angeles , CA , USA
| | - Catherine Metayer
- k Department of Epidemiology , University of California Berkeley , Berkeley , CA , USA
| | - Manuela A Orjuela-Grimm
- l Departments of Epidemiology and Pediatrics (Oncology) , Columbia University , New York , NY , USA
| | - Kira Bona
- m Department of Pediatrics , Harvard University , Boston , MA , USA
- n Department of Pediatric Oncology , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Paula Aristizabal
- o Department of Pediatrics , University of California San Diego , San Diego , CA , USA
- p Rady Children's Hospital , San Diego , CA , USA
| | - Mary T Austin
- q Department of Pediatric Surgery , The University of Texas Health Science Center at Houston , Houston , TX , USA
- r Departments of Surgical Oncology and Pediatrics Patient Care , MD Anderson Cancer Center , Houston , TX , USA
| | - Karen R Rabin
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - Heidi V Russell
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
| | - David G Poplack
- a Section of Hematology-Oncology, Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA
- b Cancer and Hematology Centers , Texas Children's Hospital , Houston , TX , USA
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14
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Jiang J, Song X, Yang J, Lei K, Ni Y, Zhou F, Sun L. Triptolide Inhibits Proliferation and Migration of Human Neuroblastoma SH-SY5Y Cells by Upregulating MicroRNA-181a. Oncol Res 2018; 26:1235-1243. [PMID: 29426375 PMCID: PMC7844704 DOI: 10.3727/096504018x15179661552702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neuroblastoma is the primary cause of cancer-related death for children 1 to 5 years of age. New therapeutic strategies and medicines are urgently needed. This study aimed to investigate the effects of triptolide (TPL), the major active component purified from Tripterygium wilfordii Hook F, on neuroblastoma SH-SY5Y cell proliferation, migration, and apoptosis, as well as underlying potential mechanisms. We found that TPL inhibited SH-SY5Y cell viability, proliferation, and migration, but induced cell apoptosis. The expression of matrix metalloproteinase-2 (MMP-2) and MMP-9 after TPL treatment in SH-SY5Y cells was decreased. The expression of microRNA-181a (miR-181a) was upregulated after TPL treatment. Moreover, suppression of miR-181a reversed the effects of TPL on SH-SY5Y cell proliferation, apoptosis, and migration. Overexpression of miR-181a enhanced the TPL-induced activation of p38 mitogen-activated protein kinase (p38MAPK) and nuclear factor κ light chain enhancer of activated B cells (NF-κB) pathways. In conclusion, our research verified that TPL inhibited the proliferation and migration of human neuroblastoma SH-SY5Y cells by upregulating the expression of miR-181a.
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Affiliation(s)
- Jian Jiang
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Xuewen Song
- Outpatient Department, Qingdao No. 1 Sanitarium, Qingdao, Shandong, P.R. China
| | - Jing Yang
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Ke Lei
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Yongan Ni
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Fei Zhou
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
| | - Lirong Sun
- Department of Pediatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, P.R. China
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15
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Georgakis MK, Dessypris N, Baka M, Moschovi M, Papadakis V, Polychronopoulou S, Kourti M, Hatzipantelis E, Stiakaki E, Dana H, Bouka E, Antunes L, Bastos J, Coza D, Demetriou A, Agius D, Eser S, Gheorghiu R, Sekerija M, Trojanowski M, Zagar T, Zborovskaya A, Ryzhov A, Tragiannidis A, Panagopoulou P, Steliarova-Foucher E, Petridou ET. Neuroblastoma among children in Southern and Eastern European cancer registries: Variations in incidence and temporal trends compared to US. Int J Cancer 2017; 142:1977-1985. [PMID: 29250786 DOI: 10.1002/ijc.31222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/29/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Marios K. Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
| | - Margarita Baka
- Department of Pediatric Hematology-Oncology; “Pan. & Agl. Kyriakou” Children's Hospital; Athens Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics; University of Athens, “Agia Sofia” Children's Hospital; Athens Greece
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology; “Agia Sofia” Children's Hospital; Athens Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology; “Agia Sofia” Children's Hospital; Athens Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology; Hippokration Hospital; Thessaloniki Greece
| | - Emmanuel Hatzipantelis
- 2nd Hematology Oncology Unit, 2nd Pediatric Department; Aristotle University of Thessaloniki, AHEPA Hospital; Thessaloniki Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology; University of Crete; Heraklion Greece
| | - Helen Dana
- Department of Pediatric Hematology-Oncology; “Mitera” Children's Hospital; Athens Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology; Porto Portugal
| | - Joana Bastos
- Registo Oncológico Regional do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E.; Coimbra Portugal
| | - Daniela Coza
- The Oncology Institute “Prof. Dr. Ion Chiricuţă”; Cluj-Napoca Romania
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health; Nicosia Cyprus
| | - Domenic Agius
- Department for Policy in Health - Health Information and Research; Malta National Cancer Registry; Pieta Malta
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe; University Institute of Public Health; Ankara Turkey
| | - Raluca Gheorghiu
- Regional Cancer Registry, National Institute of Public Health; Iasi Romania
| | - Mario Sekerija
- Croatian Institute of Public Health, Croatian National Cancer Registry; Zagreb Croatia
- Andrija Štampar School of Public Health, School of Medicine; University of Zagreb; Zagreb Croatia
| | - Maciej Trojanowski
- Wielkopolskie Centrum Onkologii, Poznan University of Medical Sciences; Poznan Poland
| | - Tina Zagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana; Ljubljana Slovenia
| | - Anna Zborovskaya
- Belarusian Research Center for Paediatric Oncology, Haematology and Immunology; Childhood Cancer Subregistry of Belarus; Minsk Belarus
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer; Kiev Ukraine
| | - Athanassios Tragiannidis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
- 2nd Hematology Oncology Unit, 2nd Pediatric Department; Aristotle University of Thessaloniki, AHEPA Hospital; Thessaloniki Greece
| | - Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
- Fourth Department of Pediatrics; Medical School, General Hospital “Papageorgiou”, Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Eleni Th. Petridou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
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16
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Berthold F, Spix C, Kaatsch P, Lampert F. Incidence, Survival, and Treatment of Localized and Metastatic Neuroblastoma in Germany 1979-2015. Paediatr Drugs 2017; 19:577-593. [PMID: 28786082 PMCID: PMC5680382 DOI: 10.1007/s40272-017-0251-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A comprehensive clinical long-term survey over the complete spectrum of neuroblatoma disease is lacking in the literature. OBJECTIVE Our objective was to describe the incidence, risk profiles, therapies, and outcomes for the total cohort of German patients with neuroblastoma including all clinical stages and risk groups. METHODS Epidemiological, clinical, and outcome data of neuroblastoma patients who participated in one of the six consecutive national trials between 1979 and 2015 were analyzed retrospectively. RESULTS Of all German neuroblastoma patients known to the national childhood cancer registry, ninety seven percent enrolled in one of the trials. The absolute neuroblastoma rate has increased slightly, whereas the median age at diagnosis has decreased. Except for the screening period (1995-2000), the risk factors lactate dehydrogenase (LDH), ferritin, chromosome 1p, and the MYCN oncogene have remained largely constant, with the exception of an increase in MYCN amplification at stage 4 for those aged ≥18 months between trials NB97 (27%) and NB2004 (35%). The 10-year overall survival increased in patients with stage 1-3 neuroblastoma from 83 to 91%, for stage 4S from 80 to 85%, and for stage 4 aged ≥18 months from 2 to 38%. The fraction of patients in stages 1-3 who never received chemotherapy (neither for frontline nor at recurrence) increased from 35 to 60%. The proportion of macroscopically complete surgical resections of the primary tumor decreased for the total population as well as for patients with stage 4 aged ≥18 months. The impact of chemotherapy response on the outcome was trial dependent. The overall proportion of toxic death during the time of the protocol therapy was 6% for stage 4 patients aged ≥18 months and 2% for low-/intermediate-risk patients. The most frequently reported late sequelae in stage 4 patients aged ≥18 months were renal dysfunctions, hypothyroidism, major hearing impairment, and second malignancies. CONCLUSION The body of data for incidences, risk profiles, and survival rates from this survey of more than 37 years provides a useful perspective for future studies on neuroblastoma sub-cohorts.
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Affiliation(s)
- Frank Berthold
- Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Claudia Spix
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Peter Kaatsch
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Fritz Lampert
- 0000 0001 2165 8627grid.8664.cDepartment of Pediatric Oncology and Hematology, Children’s Hospital, University of Giessen, Giessen, Germany
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