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Bayesian inference for survival prediction of childhood Leukemia. Comput Biol Med 2023; 156:106713. [PMID: 36863191 DOI: 10.1016/j.compbiomed.2023.106713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Childhood Leukemia is the most common type of cancer among children. Nearly 39% of cancer-induced childhood deaths are attributable to Leukemia. Nevertheless, early intervention has long been underdeveloped. Moreover, there are still a group of children succumbing to their cancer due to the cancer care resource disparity. Therefore, it calls for an accurate predictive approach to improve childhood Leukemia survival and mitigate these disparities. Existing survival predictions rely on a single best model, which fails to consider model uncertainties in predictions. Prediction from a single model is brittle, with model uncertainty neglected, and inaccurate prediction could lead to serious ethical and economic consequences. METHODS To address these challenges, we develop a Bayesian survival model to predict patient-specific survivals by taking model uncertainty into account. Specifically, we first develop a survival model predict time-varying survival probabilities. Second, we place different prior distributions over various model parameters and estimate their posterior distribution with full Bayesian inference. Third, we predict the patient-specific survival probabilities changing with respect to time by considering model uncertainty induced by posterior distribution. RESULTS Concordance index of the proposed model is 0.93. Moreover, the standardized survival probability of the censored group is higher than that of the deceased group. CONCLUSIONS Experimental results indicate that the proposed model is robust and accurate in predicting patient-specific survivals. It can also help clinicians track the contribution of multiple clinical attributes, thereby enabling well-informed intervention and timely medical care for childhood Leukemia.
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Prediction of Cancer-Specific Survival of Brainstem Glioma in Children Based on Risk Stratification Model. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3436631. [PMID: 35912147 PMCID: PMC9328996 DOI: 10.1155/2022/3436631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022]
Abstract
Objective. To develop and authenticate a risk stratification framework and nomogram for ascertaining cancer-specific survival (CSS) among the pediatric brainstem gliomas. Methods. For patients less than 12 years, according to Surveillance, Epidemiology, and End Results (SEER), information from 1998 to 2016 is found in their databases. The survival outcomes, treatments, and demographic clinicopathologic conditions are scrutinized per the database validation, and training cohorts are divided and validated using multivariate Cox regression analysis. A nomogram was designed, and predominantly, the risk stratification conceptualization engaged selected tenets according to the multivariate analysis. The model’s authenticity was substantiated through C-index measure and calibration curves. Results. There are 806 pediatric concerns of histologically concluded brainstem glioma in the research. According to multivariate analysis, age, grade, radiotherapy, and race (with
value < 0.05) depicted independent prognostic variations of the pediatric gliomas. The nomogram’s C-index was approximately 0.75 and an accompanied predictive capability for CSS. Conclusion. The nomogram constructed in this glioma’s context is the primary predictor of using risk stratification. A combination of nomograms with the risk stratification mechanism assists clinicians in monitoring high-risk individuals and engage targeted accessory treatment.
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Kakar J, Ashraf J, Khan AA, Imran M, Rehmani MA, Ghori SA, Ali MF. The Satisfactory Surgical Outcome of Posterior Fossa Brain Tumors in Children at Civil Hospital, Karachi. Asian J Neurosurg 2020; 15:377-381. [PMID: 32656135 PMCID: PMC7335127 DOI: 10.4103/ajns.ajns_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Posterior fossa brain tumor is the most devastating forms of human illness, primarily because of the limited space within the posterior fossa, the potential involvement of vital brain stem nuclei, and the mass effect causes obstructive hydrocephalus. Posterior fossa tumors are more common in children than adults. The Objective of the Study: To find out the satisfactory surgical outcome of posterior fossa brain tumors in children at Civil hospital, Karachi. Materials and Methods and Duration of Study Setting: This prospective observational, case series study was conducted from February 2015 to February 2105 in the Department of neurosurgery, Dow University of Health Sciences, Civil Hospital, Karachi, Karachi. Postoperative patients with the diagnosis of posterior fossa tumor were enrolled in the study. Detailed history, physical examination, anthropometrics, and biochemical measurements were recorded. Magnetic resonance imaging was done to determine the satisfactory surgical outcome. Patients were followed up at the third postoperative month to determine the satisfactory surgical outcome. Results: Seventy-one patients fulfilling the inclusion criteria, the mean ± standard deviation age of the study population was 6.63 ± 3.181 years. 29 (40.8%) were <7 years of age and 42 (59.2%) were of age 7 years and above. 50 (70.4%) were males and 21 (29.6%) were females. 49 (69%) patients presented with vomiting. 34 (47.9%) presented with seizures. (40.8%) had papilledema. (25.4%) presented with hemiparesis. 8 (11.3%) had meningismus. On analysis of the frequency of outcome variables (80.3%) achieved the satisfactory surgical outcome. Conclusions: There has been no major study to determine satisfactory surgical outcome in postoperative patients with posterior fossa brain tumor in our population. The study was to provide local data in our population and compare it to the international data. This may help in proper patient management. Majority of the patients had satisfactory surgical outcome. The absence of papilledema, hemiparesis, and meningismus had more chances of satisfactory surgical outcome.
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Affiliation(s)
- Jahanzeb Kakar
- Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan
| | - Junaid Ashraf
- Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan
| | - Atiq Ahmed Khan
- Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan
| | - Muhammad Imran
- Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan
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Mitchell HK, Morris M, Ellis L, Abrahão R, Bonaventure A. Racial/ethnic and socioeconomic survival disparities for children and adolescents with central nervous system tumours in the United States, 2000-2015. Cancer Epidemiol 2019; 64:101644. [PMID: 31783249 DOI: 10.1016/j.canep.2019.101644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0-19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour. METHODS 9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000-2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007. RESULTS 62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23-1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28-1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured. CONCLUSIONS Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation.
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Affiliation(s)
- Hannah K Mitchell
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, 19104, PA, USA.
| | - Melanie Morris
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Libby Ellis
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Renata Abrahão
- Brazilian Cancer Foundation, R. dos Inválidos, 212 - Centro, Rio de Janeiro - RJ, 20231-048, Brazil; Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, 4610 X St, Sacramento, 95817, CA, USA
| | - Audrey Bonaventure
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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Girardi F, Allemani C, Coleman MP. Worldwide Trends in Survival From Common Childhood Brain Tumors: A Systematic Review. J Glob Oncol 2019; 5:1-25. [PMID: 31682549 PMCID: PMC6882508 DOI: 10.1200/jgo.19.00140] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The histology of brain tumors determines treatment and predicts outcome. Population-based survival reflects the effectiveness of a health care system in managing cancer. No systematic review of worldwide variation and time trends in survival from brain tumors in children is currently available. PATIENTS AND METHODS We considered longitudinal, observational studies comprising children diagnosed with intracranial astrocytic or embryonal tumors. We searched six electronic databases from database inception to September 30, 2018, using complex search strategies. The outcome measure was 5-year survival, estimated through a time-to-event analysis. This study is registered with PROSPERO, number CRD42018111981. RESULTS Among 5,244 studies, we identified 47 eligible articles that provided 228 survival estimates. Only five studies were entirely or partially conducted in low-income or middle-income countries. Five-year survival from embryonal tumors increased from 37% in 1980 to approximately 60% in 2009. Although survival for medulloblastoma improved substantially (from 29% to 73% during 1959-2009), survival for primitive neuroectodermal tumors wavered over time (1973-2009) and between countries. Five-year survival from astrocytoma changed very little over the 27 years between 1982 and 2009 (from 78% to 89%). Interpretation of the literature was made difficult by the heterogeneity of study designs. CONCLUSION Survival has improved for embryonal tumors, but little change has been observed for astrocytic tumors. We found a striking gap in knowledge about survival from childhood brain tumor subtypes in middle-income and low-income countries, where half of these tumors are diagnosed. Larger studies are needed, including in under-represented countries and based on standardized data collection, to provide up-to-date survival estimates.
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Affiliation(s)
- Fabio Girardi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Allemani
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Berkman JM, Dallas J, Lim J, Bhatia R, Gaulden A, Gannon SR, Shannon CN, Esbenshade AJ, Wellons JC. Social determinants of health affecting treatment of pediatric brain tumors. J Neurosurg Pediatr 2019; 24:159-165. [PMID: 31125958 PMCID: PMC10171989 DOI: 10.3171/2019.4.peds18594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 04/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Little is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival. METHODS The authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children's Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson's chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05. RESULTS The analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified. CONCLUSIONS No significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.
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Affiliation(s)
- Jillian M Berkman
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 5Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Jonathan Dallas
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 2Vanderbilt University School of Medicine
| | - Jaims Lim
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 6Department of Neurosurgery, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York at Buffalo, New York
| | - Ritwik Bhatia
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 2Vanderbilt University School of Medicine
| | - Amber Gaulden
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
| | - Stephen R Gannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 3Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 3Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Adam J Esbenshade
- 4Department of Pediatrics, Division of Hematology-Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Wellons
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt
- 3Department of Neurological Surgery, Vanderbilt University Medical Center
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Austin MT, Hamilton E, Zebda D, Nguyen H, Eberth JM, Chang Y, Elting LS, Sandberg DI. Health disparities and impact on outcomes in children with primary central nervous system solid tumors. J Neurosurg Pediatr 2016; 18:585-593. [PMID: 27540957 DOI: 10.3171/2016.5.peds15704] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Health disparities in access to care, early detection, and survival exist among adult patients with cancer. However, there have been few reports assessing how health disparities impact pediatric patients with malignancies. The objective in this study was to examine the impact of racial/ethnic and social factors on disease presentation and outcome for children with primary CNS solid tumors. METHODS The authors examined all children (age ≤ 18 years) in whom CNS solid tumors were diagnosed and who were enrolled in the Texas Cancer Registry between 1995 and 2009 (n = 2421). Geocoded information was used to calculate the driving distance between a patient's home and the nearest pediatric cancer treatment center. Socioeconomic status (SES) was determined using the Agency for Healthcare Research and Quality formula and 2007-2011 US Census block group data. Logistic regression was used to determine factors associated with advanced-stage disease. Survival probability and hazard ratios were calculated using life table methods and Cox regression. RESULTS Children with advanced-stage CNS solid tumors were more likely to be < 1 year old, Hispanic, and in the lowest SES quartile (all p < 0.05). The adjusted odds ratios of presenting with advanced-stage disease were higher in children < 1 year old compared with children > 10 years old (OR 1.71, 95% CI 1.06-2.75), and in Hispanic patients compared with non-Hispanic white patients (OR 1.56, 95% CI 1.19-2.04). Distance to treatment and SES did not impact disease stage at presentation in the adjusted analysis. Furthermore, 1- and 5-year survival probability were worst in children 1-10 years old, Hispanic patients, non-Hispanic black patients, and those in the lowest SES quartile (p < 0.05). In the adjusted survival model, only advanced disease and malignant behavior were predictive of mortality. CONCLUSIONS Racial/ethnic disparities are associated with advanced-stage disease presentation for children with CNS solid tumors. Disease stage at presentation and tumor behavior are the most important predictors of survival.
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Affiliation(s)
- Mary T Austin
- Department of Pediatrics, Children's Cancer Hospital at The University of Texas MD Anderson Cancer Center;,Departments of 2 Surgical Oncology.,Department of Pediatric Surgery, University of Texas Medical School at Houston
| | - Emma Hamilton
- Department of Pediatric Surgery, University of Texas Medical School at Houston
| | - Denna Zebda
- Department of Pediatric Surgery, University of Texas Medical School at Houston
| | | | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | | | | | - David I Sandberg
- Neurosurgery, The University of Texas MD Anderson Cancer Center.,Department of Pediatric Surgery, University of Texas Medical School at Houston.,Department of Neurosurgery, University of Texas Health Science Center at Houston and Mischer Neuroscience Institute, Houston, Texas; and
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Adam M, Rueegg CS, Schmidlin K, Spoerri A, Niggli F, Grotzer M, von der Weid NX, Egger M, Probst-Hensch N, Zwahlen M, Kuehni CE. Socioeconomic disparities in childhood cancer survival in Switzerland. Int J Cancer 2016; 138:2856-66. [PMID: 26840758 DOI: 10.1002/ijc.30029] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/06/2015] [Accepted: 01/08/2016] [Indexed: 11/07/2022]
Abstract
In this study, we investigated whether childhood cancer survival in Switzerland is influenced by socioeconomic status (SES), and if disparities vary by type of cancer and definition of SES (parental education, living condition, area-based SES). Using Cox proportional hazards models, we analyzed 5-year cumulative mortality in all patients registered in the Swiss Childhood Cancer Registry diagnosed 1991-2006 below 16 years. Information on SES was extracted from the Swiss census by probabilistic record linkage. The study included 1602 children (33% with leukemia, 20% with lymphoma, 22% with central nervous system (CNS) tumors); with an overall 5-year survival of 77% (95%CI 75-79%). Higher SES, particularly parents' education, was associated with a lower 5-year cumulative mortality. Results varied by type of cancer with no association for leukemia and particularly strong effects for CNS tumor patients, where mortality hazard ratios for the different SES indicators, comparing the highest with the lowest group, ranged from 0.48 (95%CI: 0.28-0.81) to 0.71 (95%CI: 0.44-1.15). We conclude that even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. Factors causing these survival differences have to be further explored, to facilitate universal access to optimal treatment and finally eliminate social inequalities in childhood cancer survival.
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Affiliation(s)
- Martin Adam
- Swiss Tropical and Public Health Institute, 4002, Basel, Switzerland
- University of Basel, 4001, Basel, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
| | - Corina S Rueegg
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, 6002, Lucerne, Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
| | - Adrian Spoerri
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
| | - Felix Niggli
- Pediatric Hematology-Oncology Unit, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Michael Grotzer
- Pediatric Hematology-Oncology Unit, University Children's Hospital Zurich, University of Zurich, 8032, Zurich, Switzerland
| | - Nicolas X von der Weid
- Pediatric Hematology-Oncology Unit, University Children's Hospital Basel, University of Basel, 4056, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, 4002, Basel, Switzerland
- University of Basel, 4001, Basel, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, 3012, Bern, Switzerland
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The impact of provider surgical volumes on survival in children with primary tumors of the central nervous system--a population-based study. Acta Neurochir (Wien) 2011; 153:1219-29; discussion 1229. [PMID: 21547495 PMCID: PMC3098981 DOI: 10.1007/s00701-011-0967-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 02/07/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Provider volume is often a central topic in debates about centralization of procedures. In Norway, there is considerable variation in provider volumes of the neurosurgical centers treating children. We sought to explore long-term survival after surgery for central nervous system tumors in children in relation to regional provider volumes. METHOD Based on data from the Norwegian Cancer Registry we analyzed survival in all reported central nervous system tumors in children under the age of 16 treated over two decades, between March 1988 and April 2008; a total of 816 patients with histologically confirmed disease. RESULTS There was no overall difference in survival between regions. In the subgroup of PNET/medulloblastomas, both living in the high-provider volume health region and receiving treatment in the high-volume region was significantly associated with inferior survival. CONCLUSIONS In this population-based study of children operated over a period of two decades, we found no evidence of improved long-term survival in the high-provider volume region. Surprisingly, a subgroup analysis indicated that survival in PNET/medulloblastomas was significantly better if living outside the most populated health region with the highest provider volumes. One should, however, be careful of interpreting this directly as a symptom of quality of care, as there may be unseen confounders. Our study demonstrates that provider case volume may serve as an axiom in debates about centralization of cancer surgery while perhaps much more reliable and valid but less quantifiable factors are important for the final results.
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El-Gaidi MA. Descriptive epidemiology of pediatric intracranial neoplasms in Egypt. Pediatr Neurosurg 2011; 47:385-95. [PMID: 22776798 DOI: 10.1159/000337872] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 03/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The characteristics of 451 Egyptian children (aged 0-14 years) with primary intracranial neoplasms were investigated for demographic, clinical, topographical and pathological features using the most recent 2007 Classification of Central Nervous System Tumors. PATIENTS AND METHODS This was a retrospective study performed in the Departments of Pediatric Neurosurgery of the Cairo University Hospitals from 2005 to 2008. RESULTS There was a slight male predominance (51.4%) observed in our study, and the most affected age group was 5-9 years old (43.2%). Most of the tumors were confined to a single compartment (infratentorial in 49.7%, supratentorial in 46.6%), while 3.8% of the tumors involved multiple compartments. The most common intracranial tumors were astrocytomas (35%), medulloblastomas (18.8%), craniopharyngiomas (11.3%) and ependymomas (10%). Pilocytic astrocytomas constituted 55% of all astrocytomas and 19.3% of all brain tumors, only slightly ahead of medulloblastomas. Less common types were primitive neuroectodermal tumors (2.7%), followed by meningiomas, germ cell tumors and choroid plexus tumors (2.4% each). According to the International Classification of Diseases for Oncology Coding (ICD-O-4), benign, borderline and malignant tumors constituted 7.54, 36.14 and 56.32%, respectively. CONCLUSION The characteristics of pediatric intracranial tumors in Egypt are generally similar to those reported in the literature, with only minor differences.
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Affiliation(s)
- Mohamed Ali El-Gaidi
- Department of Neurosurgery, Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt.
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11
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Taylor AJ, Frobisher C, Ellison DW, Reulen RC, Winter DL, Taylor RE, Stiller CA, Lancashire ER, Tudor EC, Baggott C, May S, Hawkins MM. Survival After Second Primary Neoplasms of the Brain or Spinal Cord in Survivors of Childhood Cancer: Results From the British Childhood Cancer Survivor Study. J Clin Oncol 2009; 27:5781-7. [DOI: 10.1200/jco.2009.22.4386] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Survival after brain or spinal cord neoplasms is poor and varies by diagnostic group, age, grade, treatment and pretreatment factors, and location and size of tumor. We carried out a study to investigate survival and factors affecting survival of all diagnostic types of second primary brain or spinal cord neoplasms. Patients and Methods The British Childhood Cancer Survivor Study (BCCSS) is a long-term population-based follow-up study of 17,980 5-year survivors of childhood cancer. We used relative survival and multivariate Cox regression analysis to determine 5-year relative survival and factors affecting survival in second primary meningiomas and gliomas that developed in survivors included in the BCCSS. Results There were 247 second primary brain or spinal cord neoplasms, including 137 meningiomas and 73 gliomas in a young adult population. Five-year relative survival after meningiomas was similar for males (84.0%; 95% CI, 72.6% to 91.1%) and females (81.7%; 95% CI, 69.9% to 89.3%). For gliomas, 5-year relative survival was 19.5% (95% CI, 8.6% to 33.7%) for males and females. Multivariate analysis showed significant heterogeneity by decade of treatment (P = .04), grade (P = .03), and genetic risk (P = .03) for rate of mortality after a meningioma. For gliomas, survival was significantly affected by grade (P < .001). Conclusion Our results indicate survival is poor after second primary glioma in this young adult population, although survival after second primary meningioma is good. Our study has clinical implications for the surveillance of childhood cancer survivors at risk of developing second primary brain tumors, in particular survivors of childhood acute lymphoblastic leukemia or childhood brain tumors.
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Affiliation(s)
- Aliki J. Taylor
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Clare Frobisher
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - David W. Ellison
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Raoul C. Reulen
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - David L. Winter
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Roger E. Taylor
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Charles A. Stiller
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Emma R. Lancashire
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Edward C.G. Tudor
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Christina Baggott
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Shaun May
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Mike M. Hawkins
- From the Centre for Childhood Cancer Survivor Studies, Department of Public Health, Epidemiology and Biostatistics, School of Population and Health Sciences; University of Birmingham Medical School, University of Birmingham, Birmingham; Department of Clinical Oncology, Swansea University, Swansea; Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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Incidence of first primary central nervous system tumors in California, 2001-2005: children, adolescents and teens. J Neurooncol 2009; 94:263-73. [PMID: 19099198 PMCID: PMC2724634 DOI: 10.1007/s11060-009-9860-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 03/16/2009] [Indexed: 11/22/2022]
Abstract
This study used data from the California Cancer Registry to comprehensively examine first primary central nervous system tumors (PCNST) by the International Classification of Childhood Cancers (ICCC) diagnostic groups and to compare their incidence by age groups, sex, race/ethnicity, socioeconomic status and tumor behavior. The study period, 2001–2005, represents the first 5 years of benign PCNST data collection in the state. The age-adjusted incidence rates were 2.1 for malignant and 1.3 for benign per 100,000. Children younger than 5 years old had the highest incidence of malignant PCNST (2.6 per 100,000). Teens aged 15–19 had the highest incidence of benign PCNST (1.8 per 100,000). Age-specific incidence rates were nearly the same for Hispanics, non-Hispanic whites, and Asian/Pacific Islanders for malignant PCNST among children younger than 5 (2.6–2.7 per 100,000); non-Hispanic whites had the highest rates in the 5–14 year-old age group (2.5 per 100,000) and Asian/Pacific Islanders the highest among the 15–19 year old age group (2.3 per 100,000). We found no statistically significant differences in the incidence of malignant PCNST by race/ethnicity in any age group. Astrocytoma had the highest incidence for both malignant and benign histology in most age groups.
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