Socioeconomic determinants of childhood cancer outcomes in a large contemporary cohort

摘要 蔑视过去几十年来儿童癌症存活率的改善，标志着种族、民族和 结果方面的社会经济差距依然存在。与非西班牙裔白人儿童相比，非西班牙裔黑人儿童 西班牙裔儿童患多种癌症的存活率较低，包括最常见的白血病 在儿童中诊断出癌症。这些存活率差异的根本原因尚不清楚，而且 可能因癌症类型而异，生物学途径和社会经济途径都已被提出。近期 有证据表明，较低的社会经济地位(SES)与儿童时期的存活有关 癌症。儿童肿瘤学小组(COG)是一个由200多人组成的国际临床试验合作小组 总共治疗90%以上被诊断为儿童癌症的儿童和青少年的医院 在美国和加拿大。2007年，COG开设了儿童癌症登记网络(CCRN； COG协议ACCRN07)来创建研究注册表。总共有超过56,000例儿童癌症病例 在ACCRN07上注册，截至2017年12月8日注册结束。所有注册的孩子和家长 ACCRN07提供了诊断时最新的地址信息。我们将与 明尼苏达州人口中心的调查人员使用有效的美国地址对所有ACCRN07患者进行地理编码， 与社会经济状况数据联系起来，并将小区域的SES数据返回给COG进行分发。我们 将使用以下七个变量将每个地理编码地址与区块级别的人口普查数据关联起来 数据我们将使用因子分析来推导出五级SES指标。然后，我们将研究SES的影响 诱导治疗结束时残留疾病最小的风险、复发、其他严重毒性和 9,500例急性淋巴细胞白血病(ALL)患者的不良事件和存活率。总数超过9500人 ACCRN07上有有效地址的患者也将接受COG方案的治疗。我们的将是第一个 在儿童中大规模评估SES作为儿童癌症预后预测因子的研究 肿瘤学小组，并将包括每个肿瘤的详细细胞遗传学和分子特征。另外， 据我们所知，这将是对SES短期治疗毒性预测因素的第一次分析。我们将创造 对于当代的儿童癌症患者来说，这是一种非常有用的大规模资源。我们的发现 将具有翻译潜力，因为与SES相关的结果可能表明需要开发定制的 针对低资源患者群体的干预措施。此外，这一群体的效用将超出结果 通过与国家死亡指数(NDI)建立联系，以获得死亡率数据，从而了解治疗和生存情况。我们的 长期目标是了解影响儿童癌症复发、存活率、 以及幸存者的发病率负担。因此，这一努力将为有针对性的后续建议提供信息，并 降低风险的干预措施。

ABSTRACT Despites improvements in childhood cancer survival in the last several decades, marked racial, ethnic, and socioeconomic disparities in outcomes persist. Compared with non-Hispanic white children, non-Hispanic black and Hispanic children experience lower survival from many cancers, including leukemia, the most commonly diagnosed cancer in children. The underlying causes of these survival differences are poorly understood and may vary by cancer type, and both biological and socioeconomic pathways have been proposed. Recent evidence has suggested that lower socioeconomic status (SES) is associated with survival from some childhood cancers. The Children's Oncology Group (COG) is an international clinical trial cooperative group of over 200 hospitals which together treat more than 90% of all children and adolescents diagnosed with childhood cancer in the United States and Canada. In 2007 the COG opened the Childhood Cancer Registration Network (CCRN; COG protocol ACCRN07) to create a research registry. A total of over 56,000 childhood cancer cases were enrolled on ACCRN07 through the end of enrollment on December 8, 2017. All children and parents enrolled on ACCRN07 provided address information which was current at the time of diagnosis. We will work with investigators at the Minnesota Population Center to geocode all ACCRN07 patients with a valid U.S. address, contextualize with socioeconomic status data, and return small-area SES data to COG for dissemination. We will contextualize each geocoded address with Census data at the block level using seven variables from these data we will use factor analysis to derive a five-level SES indicator. We will then examine the influence of SES on risk of minimum residual disease at the end of induction therapy, relapse, other serious toxicities and adverse events, and survival in >9,500 acute lymphoblastic leukemia (ALL) patients. Over 9,500 ALL patients on ACCRN07 with a valid address will also have been treated on COG protocols. Ours will be the first study to evaluate SES as a predictor of childhood cancer outcomes on a large scale within the Children's Oncology Group, and will include detailed cytogenetic and molecular characterization of each tumor. Additionally, to our knowledge, this will be the first analysis of SES predictors of short-term treatment toxicities. We will create a highly useful resource on a large scale for a contemporary cohort of childhood cancer patients. Our findings will have translational potential in that outcomes related to SES may indicate the need to develop tailored interventions for low-resource patient populations. Additionally, this cohort's utility will extend beyond outcomes of therapy and into survivorship with linkages to the National Death Index (NDI) to obtain mortality data. Our long-term goal is to understand the factors that contribute to disparities in childhood cancer relapse, survival, and the burden of morbidity in survivors. Thus, this effort will inform targeted follow-up recommendations and risk-reducing interventions.