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.
- 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.)
- Subjects :
- Adolescent
Age Distribution
Age of Onset
Australia epidemiology
Bone Marrow Neoplasms mortality
Child
Child, Preschool
Disease-Free Survival
Europe epidemiology
Humans
Infant
Japan epidemiology
Neuroblastoma secondary
Neuroblastoma therapy
North America epidemiology
Prognosis
Risk Factors
Bone Marrow Neoplasms secondary
Neuroblastoma mortality
Subjects
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