Improving Pediatric Neuro-Oncology Survival Disparities in the United States-Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico.
Improving Pediatric Neuro-Oncology Survival Disparities in the United States-Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico.
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DOI：
10.1200/go.20.00377
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发表时间：
2020-11
影响因子：
4.5
通讯作者：
Crawford JR
中科院分区：
文献类型：
--
作者：
Aristizabal P;Burns LP;Kumar NV;Perdomo BP;Rivera-Gomez R;Ornelas MA;Gonda D;Malicki D;Thornburg CD;Roberts W;Levy ML;Crawford JR
治疗患有中枢神经系统肿瘤 (CNST) 的儿童需要采用复杂的跨学科方法，而这种方法在低收入和中等收入国家很少有。我们在圣地亚哥拉迪儿童医院 (RCHSD) 和墨西哥蒂华纳总医院 (HGT) 之间建立了跨境神经肿瘤项目 (CBNP)，为在 HGT 诊断出 CNST 的儿童提供神经肿瘤护理，包括神经外科服务。我们的目的是评估美国-墨西哥边境 CBNP 的可行性，并通过实施 CBNP 提高 HGT 患有 CNST 的儿童的生存率。我们前瞻性评估了 2010 年至 2017 年接受 HGT 治疗的 CNST 儿童的临床病理学特征、切除范围、无进展生存期和总生存期 (OS)。研究期间有 60 名 CNST 患者参加了 CBNP。最常见的诊断是低级别胶质瘤（24.5%）和髓母细胞瘤（22.4%）。在符合手术条件的患者中，49 名患者在 RCHSD 接受了切除手术，然后返回 HGT 进行协作管理。 RCHSD 的 78% 病例实现了肉眼全切除，而 HGT 的比例为 0% (P < .001)，并且是 5 年 OS 的预测因子（风险比，0.250；95% CI，0.067 至 0.934；P = .024）。五年总生存率从 2010 年之前的 0% 提高到 2017 年的 52%。CBNP 通过两国资源和专业知识交流，为墨西哥服务不足的儿童提供了复杂的神经肿瘤护理服务。 CBNP 患者的生存率显着提高。 RCHSD 的肉眼全切除与较高的 OS 相关，凸显了经验丰富的神经外科医生在 CNST 治疗中的关键作用。 CBNP 模式为低收入和中等收入国家需要复杂神经肿瘤学护理的 CNST 儿童提供了一个有吸引力的替代方案，特别是那些靠近高收入国家拥有广泛神经肿瘤学专业知识的机构的儿童。
Treatment of children with CNS tumors (CNSTs) demands a complex, interdisciplinary approach that is rarely available in low- and middle-income countries. We established the Cross-Border Neuro-Oncology Program (CBNP) between Rady Children’s Hospital, San Diego (RCHSD), and Hospital General, Tijuana (HGT), Mexico, to provide access to neuro-oncology care, including neurosurgic services, for children with CNSTs diagnosed at HGT. Our purpose was to assess the feasibility of the CBNP across the United States-Mexico border and improve survival for children with CNSTs at HGT by implementing the CBNP. We prospectively assessed clinicopathologic profiles, the extent of resection, progression-free survival, and overall survival (OS) in children with CNSTs at HGT from 2010 to 2017. Sixty patients with CNSTs participated in the CBNP during the study period. The most common diagnoses were low-grade glioma (24.5%) and medulloblastoma (22.4%). Of patients who were eligible for surgery, 49 underwent resection at RCHSD and returned to HGT for collaborative management. Gross total resection was achieved in 78% of cases at RCHSD compared with 0% at HGT (P < .001) and was a predictor of 5-year OS (hazard ratio, 0.250; 95% CI, 0.067 to 0.934; P = .024). Five-year OS improved from 0% before 2010 to 52% in 2017. The CBNP facilitated access to complex neuro-oncology care for underserved children in Mexico through binational exchanges of resources and expertise. Survival for patients in the CBNP dramatically improved. Gross total resection at RCHSD was associated with higher OS, highlighting the critical role of experienced neurosurgeons in the treatment of CNSTs. The CBNP model offers an attractive alternative for children with CNSTs in low- and middle-income countries who require complex neuro-oncology care, particularly those in close proximity to institutions in high-income countries with extensive neuro-oncology expertise.