Persistence of racial and ethnic disparities in risk and survival for patients with neuroblastoma over two decades

Abstract

BackgroundRacial/ethnic survival disparities in neuroblastoma were first reported more than a decade ago. We sought to investigate if these disparities have persisted with current era therapy. MethodsTwo patient cohorts were identified in the International Neuroblastoma Risk Group Data Commons (INRGdc) (Cohort 1: diagnosed 2001–2009, n = 4359; Cohort 2: diagnosed 2010–2019, n = 4891). Chi-squared tests were used to assess the relationship between race/ethnicity and clinical and biologic features. Survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression analyses were performed to investigate the association between racial/ethnic groups and prognostic markers. ResultsSignificantly higher 5-year event-free survival (EFS) and overall survival (OS) were observed for Cohort 2 compared to Cohort 1 (P < 0.001 and P < 0.001, respectively). Compared to White patients, Black patients in both cohorts had a higher proportion of high-risk disease (Cohort 1: P < 0.001; Cohort 2: P < 0.001) and worse EFS (Cohort 1: P < 0.001; Cohort 2 P < 0.001) and OS (Cohort 1: P < 0.001; Cohort 2: P < 0.001). In Cohort 1, Native Americans also had a higher proportion of high-risk disease (P = 0.03) and inferior EFS/OS. No significant survival disparities were observed for low- or intermediate-risk patients in either cohort or high-risk patients in Cohort 1. Hispanic patients with high-risk disease in Cohort 2 had significantly inferior OS (P = 0.047). Significantly worse OS, but not EFS, (P = 0.006 and P = 0.02, respectively) was also observed among Black and Hispanic patients assigned to receive post-Consolidation dinutuximab on clinical trials (n = 885). ConclusionRacial/ethnic survival disparities have persisted over time and were observed among high-risk patients assigned to receive post-Consolidation dinutuximab.