Racial and ethnic disparities in disease presentation and survival among children with neuroblastoma (NBL): A Children's Oncology Group (COG) study.

Abstract

9517 Background: The role of race and ethnicity in disease presentation and survival among children with NBL remains unclear. We investigated the relationship between race/ethnicity, NBL biology, and outcome using data from the COG NBL biology protocol ANBL00B1. Methods: Disease presentation and survival probabilities were compared among white, black, Hispanic, Asian, and Native American children. Analysis of disease outcome was measured as overall (OS) and event-free survival (EFS), and was adjusted for prognostic clinical features and disease biology. Results: 3,923 children with NBL enrolled between 2001 and 2009 were included. Non-hispanic whites (“white”) constituted 73% of the cohort; 11% were Hispanic, 11% non-hispanic black (“black”), 4% Asian, and 1% Native-American. When compared with whites, blacks and Native-Americans were more likely to present with high-risk disease (blacks: 56% vs. 43%, p<0.001, Native-American: 66% vs. 43%, p=0.04). The prevalence of high-risk disease among Asian and Hispanic children did not differ from whites. Three-year EFS was: Hispanics, 74%, whites, 69%, blacks, 63%, Asians, 62%, and Native- Americans, 38%, (p<0.001). Although univariate analysis revealed worse EFS for blacks (HR 1.28; p=0.01) and Native-Americans (HR 2.33; p=0.003), when compared with whites, adjustment for risk group abrogated these differences. However, examination of EFS by follow-up time (<2 years vs. 2+ years from diagnosis) revealed a higher prevalence of late-occurring events among blacks as compared with whites. This was confirmed in the multivariate analyses restricted to 2+ year survivors, where blacks had significantly worse EFS (HR=1.5, p=0.04) as compared with whites. Conclusions: Black and Native-American children are more likely to present with high-risk NBL. Blacks demonstrate a propensity for delayed events, causing a divergence in EFS with follow-up from diagnosis. Studies are being planned to delineate the role of genetic predisposition in the racial differences in prevalence of high risk NBL, as well as survival outcomes. No significant financial relationships to disclose.