Evidence for an age cutoff greater than 365 days for neuroblastoma risk group stratification in the Children's Oncology Group
Evidence for an age cutoff greater than 365 days for neuroblastoma risk group stratification in the Children's Oncology Group
复制标题
DOI：
10.1200/jco.2005.05.571
复制
发表时间：
2005-09-20
影响因子：
45.3
通讯作者：
Cohn, SL
中科院分区：
文献类型：
--
作者：
London, WB;Castleberry, RP;Cohn, SL
在儿童肿瘤组中，神经母细胞瘤的风险组分配对治疗决策至关重要，患者根据国际神经母细胞瘤分期系统分期、MYCN状态、倍性、岛田组织病理学和诊断年龄进行分层。年龄小于365天与预后良好相关，但最近的研究表明，年龄越长，预后的准确性越高。方法回顾性分析儿童肿瘤组生物学研究9047和儿童癌症组研究321 p1-p4、3881、3891和B973的数据，包括3666例患者（1986 - 2001）的年龄和随访数据，以确定最佳年龄截止点。27个独立的分析，每个针对不同的年龄界限（调整MYCN和阶段），测试了年龄对结果的影响。选择使年轻和老年患者之间的结果差异最大化的截止点。结果37%的患者年龄小于365天，64%的患者年龄小于365天。365天龄（4年无事件生存率[EFS] SE分别为83% +/- 1% [n = 1339]和45% +/- 1% [n = 2327], P < 0.0001）。图形分析揭示了年龄对预后影响的连续性。我们选择的最佳460天的截止时间最大限度地提高了年轻和老年患者之间的结果差异。43%小于460日龄，57%为460日龄（4年EFS率+/- SE分别为82% +/- 1% [n = 1589]和42% +/- 1% [n = 2077], P < 0.0001）。使用460天的临界值（假设4期，mycn扩增的患者仍然是高风险的），5%的患者（365至460天：4年EFS 92% +/- 3%； n = 135）属于低风险组。结论年龄对预后的影响是连续的。在临床相关的风险分层中，存在460天的年龄界限的统计支持。
Purpose In the Children's Oncology Group, risk group assignment for neuroblastoma is critical for therapeutic decisions, and patients are stratified by International Neuroblastoma Staging System stage, MYCN status, ploidy, Shimada histopathology, and diagnosis age. Age less than 365 days has been associated with favorable outcome, but recent studies suggest that older age cutoff may improve prognostic precision.Methods To identify the optimal age cutoff, we retrospectively analyzed data from the Pediatric Oncology Group biology study 9047 and Children's Cancer Group studies 321 p1-p4, 3881, 3891, and B973 on 3,666 patients (1986 to 2001) with documented ages and follow-up data. Twenty-seven separate analyses, one for each different age cutoff (adjusting for MYCN and stage), tested age influence on outcome. The cutoff that maximized outcome difference between younger and older patients was selected.Results Thirty-seven percent of patients were younger than 365 days, and 64% were ! 365 days old (4-year event-free survival [EFS] rate SE: 83% +/- 1% [n = 1,339] and 45% +/- 1 % [n = 2,327], respectively; P < .0001). Graphical analyses revealed the continuous nature of the prognostic contribution of age to outcome. The optimal 460-day cutoff we selected maximized the outcome difference between younger and older patients. Forty-three percent were younger than 460 days, and 57% were : 460 days old (4-year EFS rate +/- SE: 82% +/- 1 % [n = 1,589] and 42% +/- 1 % [n = 2,077], respectively; P < .0001). Using a 460-day cutoff (assuming stage 4, MYCN-amplified patients remain high-risk), 5% of patients (365 to 460 days: 4-year EFS 92% +/- 3%; n = 135) fell into a lower risk group.Conclusion The prognostic contribution of age to outcome is continuous in nature. Within clinically relevant risk stratification, statistical support exists for an age cutoff of 460 days.