University of Chicago Medical Center
Black, Asian, and Native American children are more likely than white and Hispanic children to die after being treated for neuroblastoma, according to new research on the pediatric cancer. The study, of more than 3,500 patients with the disease, is the largest ever to look at racial disparities in risk and survival for the most common solid cancer found in young children.
The study also found that black and Native American children are more likely to have the high-risk form of the disease and show signs of resistance to modern treatment. Those biological characteristics suggest that genetic factors contribute to the outcome disparities found for neuroblastoma.
“Disparities in outcome according to race do exist in neuroblastoma,” said Susan Cohn, MD, professor of pediatrics at Comer Children’s Hospital at the University of Chicago Medical Center and senior author of the study. “There are racial cohorts of patients who do more poorly than the white population.”
The analysis, published online November 22 by the Journal of Clinical Oncology, uses data collected by the Children’s Oncology Group (COG), a partnership of more than 200 clinical sites in North America. Because neuroblastoma is a rare cancer, with only 650 new cases each year in the United States, the large coalition was essential to follow enough patients to answer questions about race and ethnicity, Cohn said.
“This kind of study has largely been impeded by the very small numbers of patients that we see, and the small numbers of minorities within that subset,” Cohn said. “Through the COG infrastructure, we are able to collect data on the vast majority of patients who are diagnosed with neuroblastoma in North America. It’s a much richer data set.”
A subject pool of 3,500 children diagnosed between 2001 and 2009 enabled a research group led by Cohn and Tara Henderson, MD, MPH, Assistant Professor of Pediatrics, to compare children of different races on neuroblastoma risk and survival. While 75 percent of white and Hispanic patients survived five years after diagnosis, only 67 percent of black patients, 63 percent of Asian patients, and 39 percent of Native American patients survived to that point.
Patients diagnosed with neuroblastoma are classified as having low-risk, intermediate-risk, or high-risk disease based on a number of clinical and biological factors. Black children in the study had a higher prevalence of high-risk disease (57 percent) compared to white children (44 percent). Black patients also more frequently displayed individual predictors of high-risk disease, such as older age at diagnosis, stage 4 disease, and unfavorable histology.
“By definition, if you are older and have advanced stage disease, you are at high risk for relapse and more difficult to cure,” Cohn said. “The major reason why the black patients do worse is because there are more of them in this high-risk group.”
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