Demographics, patterns of care, and survival in pediatric medulloblastoma.
Demographics, patterns of care, and survival in pediatric medulloblastoma.
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DOI：
10.1007/s11060-017-2400-5
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发表时间：
2017-05
影响因子：
3.9
通讯作者：
Villano JL
中科院分区：
文献类型：
--
作者：
Dressler EV;Dolecek TA;Liu M;Villano JL
我们评估了美国外科医师学会的国家癌症数据库（NCDB），以描述目前以医院为基础的儿科髓母细胞瘤的流行病学频率、生存率和护理模式。我们使用logistic和Poisson回归、Kaplan-Meier生存估计和考克斯比例风险模型分析了NCDB 1998-2011年0-19岁儿童髓母细胞瘤的数据。在0-19岁的人群中发现了3，647例髓母细胞瘤。79%接受化疗，74%接受放疗，65%接受两种治疗。那些接受放射治疗的人更有可能超过四岁，而那些接受化疗的人更有可能是四岁或更年轻。与既不接受放疗也不接受化疗相关的变量包括诊断时年龄<1岁、女性、非黑人或白色种族、没有保险、居住在高中毕业生水平低的住宅区。在女性中，随着诊断时年龄的增加和接受过放射治疗，观察到更好的总生存率。与髓母细胞瘤NOS相比，观察到退行性髓母细胞瘤患者的生存率更高，而大细胞髓母细胞瘤患者的生存率更低。大多数患者接受了多学科治疗，放射治疗对生存率的影响最大。四岁及以下的儿童最有可能接受化疗，最不可能接受放疗。次优治疗包括17.8%未接受化疗，其中11.8%既未接受化疗也未接受放疗。与医疗可及性相关的差异是未接受标准治疗的特征，这导致了不良结局。
We evaluated the American College of Surgeon’s National Cancer Data Base (NCDB) to describe current hospital-based epidemiologic frequency, survival, and patterns of care of pediatric medulloblastoma. We analyzed NCDB 1998–2011 data on medulloblastoma for children ages 0–19 years using logistic and poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. 3,647 cases of medulloblastoma in those aged 0–19 years were identified. Chemotherapy was received by 79% and 74% received radiation, with 65% receiving both therapies. Those who received radiation were more likely to be older than four, while those who received chemotherapy were more likely to be age four and younger. Variables associated with receipt of neither radiation nor chemotherapy included age at diagnosis of <1 year, female gender, being of race other than black or white, having no insurance, and living in a residential area with a low level of high school graduates. Better overall survival was observed as age at diagnosis increased, in females, and having received radiation. Compared to medulloblastoma, NOS, better survival was observed for those with demoplastic medulloblastoma, with worse survival in those with large cell medulloblastoma. Majority received multi- disciplinary therapy and radiation had the greatest effect on survival. Ages four and under were most likely to receive chemotherapy and least likely to receive radiation. Suboptimal treatment included 17.8% that did not receive chemotherapy, of which 11.8% received neither chemotherapy nor radiation. Disparities associated with medical access were characteristics for not receiving standard treatment, which resulted in poor outcome.