Back to Search Start Over

Changes over three decades in outcome and the prognostic influence of age-at-diagnosis in young patients with neuroblastoma: a report from the International Neuroblastoma Risk Group Project.

Authors :
Moroz V
Machin D
Faldum A
Hero B
Iehara T
Mosseri V
Ladenstein R
De Bernardi B
Rubie H
Berthold F
Matthay KK
Monclair T
Ambros PF
Pearson AD
Cohn SL
London WB
Source :
European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2011 Mar; Vol. 47 (4), pp. 561-71. Date of Electronic Publication: 2010 Nov 26.
Publication Year :
2011

Abstract

Purpose: Increasing age has been an adverse risk factor in children with neuroblastoma (NB) since the 1970's, with a 12-month age-at-diagnosis cut-off for treatment stratification. Over the last 30 years, treatment intensity for children >12 months with advanced-stage disease has increased; to investigate if this strategy has improved outcome and/or reduced the prognostic influence of age, we analysed the International Neuroblastoma Risk Group (INRG) database.<br />Patients and Methods: Data from 11,037 children with NB (1974-2002) from Australia, Europe, Japan, North America. Cox modelling of event-free survival (EFS) tested if the era and prognostic significance of age-of-diagnosis, adjusted for bone marrow (BM) metastases and MYCN status, effects on outcome had changed.<br />Results: Outcome improved over time: 3-year EFS 46% (1974-1989) and 71% (1997-2002). The risk for those >18 months against ≤12 decreased: hazard ratio (HR); 4.61 and 3.94. For age 13-18 months, EFS increased from 42% to 77%. Outcome was worse if: >18 months (HR 4.47); BM metastases (HR 4.00); and MYCN amplified (HR 3.97). For 1997-2002, the EFS for >18 months with BM involvement and MYCN amplification was 18%, but 89% for 0-12 months with neither BM involvement nor MYCN amplification.<br />Conclusions: There is clear evidence for improving outcomes for children with NB over calendar time. The adverse influence of increasing age-at-diagnosis has declined but it remains a powerful indicator of unfavourable prognosis. These results support the age-of-diagnosis cut-off of greater than 18 months as a risk criterion in the INRG classification system.<br /> (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1879-0852
Volume :
47
Issue :
4
Database :
MEDLINE
Journal :
European journal of cancer (Oxford, England : 1990)
Publication Type :
Academic Journal
Accession number :
21112770
Full Text :
https://doi.org/10.1016/j.ejca.2010.10.022