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Impact of risk-based therapy on late morbidity and mortality in neuroblastoma survivors: a report from the Childhood Cancer Survivor Study.
- Source :
- JNCI: Journal of the National Cancer Institute; Jun2024, Vol. 116 Issue 6, p885-894, 10p
- Publication Year :
- 2024
-
Abstract
- Background Early efforts at risk-adapted therapy for neuroblastoma are predicted to result in differential late effects; the magnitude of these differences has not been well described. Methods Late mortality, subsequent malignant neoplasms (SMNs), and severe/life-threatening chronic health conditions (CHCs), graded according to CTCAE v4.03, were assessed among 5-year Childhood Cancer Survivor Study (CCSS) survivors of neuroblastoma diagnosed 1987-1999. Using age, stage at diagnosis, and treatment, survivors were classified into risk groups (low [n = 425]; intermediate [n = 252]; high [n = 245]). Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) of SMNs were compared with matched population controls. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals for CHC compared with 1029 CCSS siblings. Results Among survivors (49.8% male; median age = 21 years, range = 7-42; median follow-up = 19.3 years, range = 5-29.9), 80% with low-risk disease were treated with surgery alone, whereas 79.1% with high-risk disease received surgery, radiation, chemotherapy ± autologous stem cell transplant (ASCT). All-cause mortality was elevated across risk groups (SMR<subscript>high</subscript> = 27.7 [21.4-35.8]; SMR<subscript>intermediate</subscript> = 3.3 [1.7-6.5]; SMR<subscript>low</subscript> = 2.8 [1.7-4.8]). SMN risk was increased among high- and intermediate-risk survivors (SIR<subscript>high</subscript> = 28.0 [18.5-42.3]; SIR<subscript>intermediate</subscript> = 3.7 [1.2-11.3]) but did not differ from the US population for survivors of low-risk disease. Compared with siblings, survivors had an increased risk of grade 3-5 CHCs, particularly among those with high-risk disease (HR<subscript>high</subscript> = 16.1 [11.2-23.2]; HR<subscript>intermediate</subscript> = 6.3 [3.8-10.5]; HR<subscript>low</subscript> = 1.8 [1.1-3.1]). Conclusion Survivors of high-risk disease treated in the early days of risk stratification carry a markedly elevated burden of late recurrence, SMN, and organ-related multimorbidity, whereas survivors of low/intermediate-risk disease have a modest risk of late adverse outcomes. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00278874
- Volume :
- 116
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- JNCI: Journal of the National Cancer Institute
- Publication Type :
- Academic Journal
- Accession number :
- 177774207
- Full Text :
- https://doi.org/10.1093/jnci/djae062