Trends in conditional survival and predictors of late death in neuroblastoma.
Trends in conditional survival and predictors of late death in neuroblastoma.
复制标题
神经母细胞瘤条件生存的趋势和晚期死亡的预测因素。
DOI：
10.1002/pbc.28329
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发表时间：
2020
影响因子：
3.2
通讯作者：
DuBois,StevenG
中科院分区：
文献类型：
--
作者：
Olsen,HannahE;Campbell,Kevin;Bagatell,Rochelle;DuBois,StevenG
目的在过去的几十年里，神经母细胞瘤的治疗取得了重大进展。很少有数据说明这些改善如何随着时间的推移而改变，并对高危和非高危患者组的条件生存率产生不同的影响。方法我们使用监测、流行病学和最终结果数据库进行了一项回溯性队列研究。我们分析了4717例神经母细胞瘤患者的临床特征和生存结果。结果高危组5年生存率为41.46%(95%可信区间38.77~44.13)，非高危组5年生存率为91.13%(95%可信区间89.49~92.53)。这两组人的操作系统在十年内都有了显著的改善(P<；10.001)。1年存活者的5年COS在高危组为52.69%(CI 49.54~55.73)，在非高危组为96.75%(95%CI 95.57~97.62)。随着时间的推移，高危组中一年的幸存者在COS方面显示出统计上的显著改善。在5年高危幸存者中没有观察到COS的差异。在高危人群和非高危人群中，晚期死亡的82%和32%分别可归因于癌症。对晚期死亡有统计学意义的不良预后因素是确诊时1岁以下的≥、转移性疾病和非胸部原发部位(P=0.001)。结论随着时间的推移，COS值的改善在很大程度上使高危患者受益，尽管与非高危患者相比，他们因癌症而晚期死亡的风险仍然更高。年龄、分期和原发部位，而不是治疗十年，会影响5年幸存者的预后。
PurposeSignificant advances in the treatment of neuroblastoma have been made in the past several decades. There are scant data examining how these improvements have changed over time and differentially affected conditional survival among high‐risk and non‐high‐risk patient groups.MethodsWe conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results database. We analyzed clinical characteristics and survival outcomes for 4717 neuroblastoma patients. Kaplan‐Meier methods were used to estimate overall survival (OS) and conditional overall survival (COS) with estimates compared between groups using log‐rank tests.ResultsFive‐year OS was 41.46% (95% CI 38.77‐44.13) for the high‐risk group and 91.13% (95% CI 89.49‐92.53) for the non‐high‐risk group. Both groups saw significant improvements in OS by decade (P< .001). Five‐year COS among 1‐year survivors was 52.69% (CI 49.54‐55.73) for the high‐risk group and 96.75% (95% CI 95.57‐97.62) for the non‐high‐risk group. One‐year survivors in the high‐risk group showed a statistically significant improvement in COS over time. No difference in COS was observed among 5‐year high‐risk survivors. In the high‐risk and non‐high‐risk groups, 82% and 32% of late deaths were attributable to cancer, respectively. Statistically significant adverse prognostic factors for late death were age ≥ 1 year at diagnosis, metastatic disease, and nonthoracic primary site (P= .001).ConclusionsImprovements in COS over time have largely benefited high‐risk patients, though they are still at higher risk for late death due to cancer when compared to non‐high‐risk patients. Age, stage, and primary site, but not treatment decade, influence outcomes among 5‐year survivors.