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Blacks, Native Americans more likely to have high-risk neuroblastoma, poorer survival
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Black and Native American children are more likely to develop high-risk neuroblastoma and subsequently have worse event-free survival compared with white patients, according to results collected by the Children’s Oncology Group.
From 2001 to 2009, 4,439 children diagnosed with neuroblastoma, ganglioneuroblastoma or maturing-type ganglioneuroma were enrolled into the study. The analytic cohort included 3,359 patients.
Racial groups were categorized as Asian (4%), black (12%), non-white Hispanic (12%), Native American (1%) and white (72%). One-third of patients were classified as low risk, 20% were intermediate risk and 46% were high risk.
Black patients were older at diagnosis, (P<.001) and had a higher prevalence of stage IV disease (P=.001) and unfavorable histology tumors (P<.001) compared with whites. Blacks also had a greater prevalence of high-risk disease (57% vs. 44%). There was no difference in the frequency of MYCN amplification (P=.27) or ploidy (P=.46).
Prevalence of high-risk disease was even greater among Native Americans compared with whites (50% vs. 43%). Prevalence was also greater among Asian patients, but the difference did not reach statistical significance. Incidence of high-risk disease was identical among whites and Hispanics.
Univariate analysis showed that OS was significantly worse for all racial groups compared with whites. Event-free survival was also significantly worse for blacks (HR=1.30) and Native Americans (HR=2.37) compared with whites.
Multivariate analysis showed that inferior event-free survival for blacks and Native Americans disappeared after adjusting for risk group. However, researchers observed inferior OS for Native Americans (HR=2.05) and Asians (HR=1.46).
In the high-risk group, 5-year OS was 48% (95% CI, 44-51) and 5-year event-free survival was 39% (95% CI, 36-42).
An analysis of patients who remained event-free for at least 2 years showed that blacks were more likely to suffer late-occurring events than whites (HR=1.50). Blacks also had worse event-free survival compared with whites among high-risk patients who remained event-free for 2 years or more (HR=1.51). There were not enough events in the low- and intermediate-risk groups to examine event-free survival.
For more information:
- Henderson TO. J Clin Oncol. 2010;doi:10.1200/JCO.2010.29.6103.