Overall survival for neuroblastoma in South Africa between 2000 and 2014.
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Child
Child, Preschool
Comorbidity
Cytoreduction Surgical Procedures
Developing Countries
Gene Amplification
Genes, myc
Health Services Accessibility
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Neoplasm Staging
Neuroblastoma
/ diagnosis
Prognosis
Proportional Hazards Models
Radiotherapy
/ methods
Retrospective Studies
South Africa
/ epidemiology
Stem Cell Transplantation
Survival Rate
Transplantation, Autologous
South Africa
neuroblastoma
outcomes
overall survival
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
17
04
2019
revised:
27
06
2019
accepted:
01
07
2019
pubmed:
2
8
2019
medline:
26
2
2020
entrez:
2
8
2019
Statut:
ppublish
Résumé
Outcome data for neuroblastoma in sub-Saharan Africa are minimal, whereas poor outcome is reported in low- and middle-income countries. A multi-institutional retrospective study across South Africa was undertaken to determine outcome. Patients treated between January 2000 and December 2014 in nine South African pediatric oncology units were included. Kaplan-Meier curves and Cox regression models were employed to determine two-year survival rates and to identify prognostic factors. Data from 390 patients were analyzed. The median age was 39.9 months (range, 0-201 months). The majority presented with stage 4 disease (70%). The main chemotherapy regimens were OPEC/OJEC (44.8%), St Jude NB84 protocol (28.96%), and Rapid COJEC (22.17%). Only 44.4% had surgery across all risk groups, whereas only 16.5% of high-risk patients received radiotherapy. The two-year overall survival (OS) for the whole cohort was 37.6%: 94.1%, 81.6%, and 66.7%, respectively, for the very-low-risk, low-risk, and intermediate-risk groups and 27.6% for the high-risk group (P < 0.001, 95% CI). The median survival time for the whole group was 13 months (mean, 41.9 months; range, 0.1-209 months). MYCN-nonamplified patients had a superior two-year OS of 51.3% in comparison with MYCN-amplified patients at 37.3% (P = 0.002, 95% CI). Limited disease had an OS comparable with high-income countries, but advanced disease had a poor OS. South Africa should focus on early diagnosis and implementation of a national protocol with equitable access to treatment.
Sections du résumé
BACKGROUND
Outcome data for neuroblastoma in sub-Saharan Africa are minimal, whereas poor outcome is reported in low- and middle-income countries. A multi-institutional retrospective study across South Africa was undertaken to determine outcome.
METHODS
Patients treated between January 2000 and December 2014 in nine South African pediatric oncology units were included. Kaplan-Meier curves and Cox regression models were employed to determine two-year survival rates and to identify prognostic factors.
RESULTS
Data from 390 patients were analyzed. The median age was 39.9 months (range, 0-201 months). The majority presented with stage 4 disease (70%). The main chemotherapy regimens were OPEC/OJEC (44.8%), St Jude NB84 protocol (28.96%), and Rapid COJEC (22.17%). Only 44.4% had surgery across all risk groups, whereas only 16.5% of high-risk patients received radiotherapy. The two-year overall survival (OS) for the whole cohort was 37.6%: 94.1%, 81.6%, and 66.7%, respectively, for the very-low-risk, low-risk, and intermediate-risk groups and 27.6% for the high-risk group (P < 0.001, 95% CI). The median survival time for the whole group was 13 months (mean, 41.9 months; range, 0.1-209 months). MYCN-nonamplified patients had a superior two-year OS of 51.3% in comparison with MYCN-amplified patients at 37.3% (P = 0.002, 95% CI).
CONCLUSIONS
Limited disease had an OS comparable with high-income countries, but advanced disease had a poor OS. South Africa should focus on early diagnosis and implementation of a national protocol with equitable access to treatment.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e27944Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Matthay K, Maris J, Schleiermacher G, et al. Neuroblastoma. Nat Rev Dis Primers. 2016;2:16078.
Parikh N, Howard S, Chantada G, et al. SIOP-PODC adapted risk stratification and treatment guidelines: recommendations for neuroblastoma in low- and middle-income settings. Pediatr Blood Cancer. 2015;62(8):1305-1316.
Pinto N, Applebaum M, Volchenboum S, et al. Advances in risk classification and treatment strategies for neuroblastoma. J Clin Oncol. 2015;33(27):3008-3017.
Whittle S, Smith V, Doherty E, et al. Overview and recent advances in the treatment of neuroblastoma. Expert Rev Anticancer Ther. 2017;17(4):369-386.
Yáñez Y, Grau E, Rodríguez-Cortez VC, et al. Two independent epigenetic biomarkers predict survival in neuroblastoma. Clin Epigenetics. 2015;7(1):16.
Stuckler D, Basu S, McKee M. Health care capacity and allocations among South Africa's provinces: infrastructure-inequality traps after the end of apartheid. Am J Public Health. 2011;101(1):165-172.
[World Bank Group Web site] 2018. https://data.worldbank.org/income-level/low-and-middle-income. Accessed Nov 12, 2018.
Israels T, Ribeiro RC, Molyneux EM. Strategies to improve care for children with cancer in sub-Saharan Africa. Eur J Cancer. 2010;46(11):1960-1966.
Mayosi B, Lawn J, Van Niekerk A, et al. Health in South Africa: changes and challenges since 2009. Lancet. 2012;380(9858):2029-2043.
Stefan D, Stones D, Wainright R, et al. Childhood cancer incidence in South Africa, 1987-2007. S Afr Med J. 2015;105(11):939-947.
Mayosi B, Benatar S. Health and health care in South Africa - 20 years after Mandela. New Engl J Med. 2014;371(14):1344-1353.
Benatar S. The challenges of health disparities in South Africa. S Afr Med J. 2013;103(3):154-155.
Brodeur G, Pritchard J, Berthold, et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol. 1993;11(8):1466-1477.
Park J, Bagatell R, Cohn S, et al. Revisions to the International Neuroblastoma Response Criteria: a consensus statement from the National Cancer Institute Clinical Trials Planning Meeting. J Clin Oncol. 2017;35(22):2580-2587.
Eisenhauer E, Therasse P, Bogaert J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228-247.
Peinemann F, Tushabe D, Berthold F. Rapid COJEC versus standard induction therapies for high-risk neuroblastoma. Cochrane Database Syst Rev;201519(5):CD010774.
Bowman L, Hancock M, Santana V, et al. Impact of intensified therapy on clinical outcome in infants and children with neuroblastoma: the St Jude Children's Research Hospital Experience, 1962 to 1988. J Clin Onco. 1991;9(9):1599-1608.
Stram D, Matthay K, O'Leary M, et al. Consolidation chemoradiotherapy and autologous bone marrow transplantation versus continued chemotherapy for metastatic neuroblastoma: a report of two concurrent Children's Cancer Group studies. J Clin Oncol. 1996;14(9):2417-2426.
Coze C, Hartmann O, Michon J, et al. NB87 induction protocol for stage 4 neuroblastoma in children over 1 year of age: a report from the French Society of Pediatric Oncology. J Clin Oncol. 1997;15(12):3433-3440.
Al-Tonbary Y, Badr M, Mansour A, et al. Clinico-epidemiology of neuroblastoma in north east Egypt: a 5-year multicenter study. Oncol Lett. 2015;10(2):1054-1062.
Duarte M, Gelmini A, Marques de Souza G. Neuroblastoma: a correlation between radiologic methods. Urol Nephrol Open Access J. 2018;6(2):65-67.
David R, Lamki N, Fan S, et al. The many faces of neuroblastoma. RadioGraphics. 1989;9(5):859-882.
Decarolis B, Hero B, Simon T, et al. Iodine-123meta-iodobenzylguanidine scintigraphy scoring allows prediction of outcome in patients with stage 4 neuroblastoma: results of the Cologne Interscore Comparison Study. J Clin Oncol;31(7):944-951.
Cohn L, Pearson A, London W, et al. The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task force report. J Clin Oncol. 2009;27(2):289-297.
Haupt R, Garaventa A, Gambini C, et al. Improved survival of children with neuroblastoma between 1979 and 2005: a report of the Italian Neuroblastoma Registry. J Clin Oncol. 2010;28(14):2331-2338.
Bansal D, Marwaha R, Trehan A, et al. Profile and outcome of neuroblastoma with conventional chemotherapy in children older than one year: a 15-years’ experience. Indian Pediatrics. 2008;45:135-139.
Kitonyi G, Macharia W, Mwanda O, Pamnani R. Clinico-pathologic characteristics and treatment outcomes in children with neuroblastoma at the Kenyatta National Hospital, Nairobi. East Afr Med J. 2009;86(12 suppl):S39-S46.
DuBois S, London W, Zhang Y, et al. Lung metastases in neuroblastoma at initial diagnosis: a report from the International Neuroblastoma Risk Group (INRG) Project. Pediatr Blood Cancer. 2008;51(5):589-592.
Moreno F, Lopez Marti J, Palladino M, et al. Childhood neuroblastoma: incidence and survival in Argentina. Report from the National Pediatric Cancer Registry, ROHA Network 2000-2012. Pediatr Blood Cancer. 2016;63(8):1362-1367.
Smith V, Foster J. High-risk neuroblastoma treatment review. Children. 2018;5(9):114.
Wang M, Zhou C, Cai R, et al. Copy number gain of MYCN gene is a recurrent genetic aberration and favorable prognostic factor in Chinese pediatric neuroblastoma patients. Diagnostic Pathology. 2013;8(5):1-6.
Seeger R, Brodeur G, Sather H, et al. Association of multiple copies of the N-myc oncogene with rapid progression of neuroblastomas. N Engl J Med. 1985;313(18):1111-1116.
Yanik G, Parisi M, Shulkin B, et al. Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4 neuroblastoma: a report from the Children's Oncology Group. J Nucl Med. 2013;54(4):541-548.
Von Allmen D, Davidoff A, London W, et al. Impact of extent of resection on local control and survival in patients from the COG A3973 study with high-risk neuroblastoma. J Clin Oncol. 2017;35(2):208-216.
Kiely E. A technique for excision of abdominal and pelvic neuroblastoma. Ann R Coll Surg Engl. 2007;98(4):342-348.
Holmes K, Poetschger U, Sarnacki S, et al. The influence of surgical excision on survival in high-risk neuroblastoma revisited after introduction of ch14.18/CHO immunotherapy in the HR-NBL1/SIOPEN trial. J Clin Oncol. 2018;36(15 suppl):10521-10521.
Pearson A, Pinkerton C, Lewis I, et al. High-dose rapid and standard induction chemotherapy for patients aged over 1 year with stage 4 neuroblastoma: a randomised trial. Lancet Oncology. 2008;9(3):247-256.
Bowmen L, Hancock M, Santana V, et al. Impact of intensified therapy on clinical outcome in infants and children with neuroblastoma: the St Jude Children's Research Hospital Experience, 1962 to 1988. J Clin Oncol. 1999;9:1599-1608.
Parize I, Haddad B, Cavalli L, et al. Neuroblastoma in southern Brazil: an 11-year study. J Pediatr Hematol Onco. 2006;28(2):82-87.
Henderson TO, Bhatia S, Pinto N, et al. Racial and ethnic disparities in risk and survival in children with neuroblastoma: a Children's Oncology Group study. J Clin Oncol. 2011;29(1):76-82.
Bauer J, Jürgens H, Frühwald M. Important aspects of nutrition in children with cancer. Adv Nutr. 2011;2(2):67-77.
Bhakta N, Martiniuk A, Gupta S, et al. The cost effectiveness of treating paediatric cancer in low-income and middle-income countries: a case-study approach using acute lymphocytic leukaemia in Brazil and Burkitt lymphoma in Malawi. Arch Dis Child. 2012;98(2):155-160.