Harvard Medical School, Boston, Massachusetts.
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts.
Pediatr Blood Cancer. 2020 Oct;67(10):e28329. doi: 10.1002/pbc.28329. Epub 2020 Jul 31.
Significant 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.
We 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.
Five-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).
Improvements 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.
在过去几十年中，神经母细胞瘤的治疗取得了重大进展。关于这些进展如何随时间变化以及对高危和非高危患者组的条件生存率产生不同影响的数据很少。
我们使用监测、流行病学和最终结果数据库进行了回顾性队列研究。我们分析了 4717 名神经母细胞瘤患者的临床特征和生存结果。Kaplan-Meier 方法用于估计总生存率（OS）和条件总生存率（COS），并使用对数秩检验比较组间估计值。
高危组的 5 年 OS 为 41.46%（95%CI 38.77-44.13），非高危组为 91.13%（95%CI 89.49-92.53）。两个组的 OS 都随时间显著改善（P<.001）。1 年幸存者中，高危组的 5 年 COS 为 52.69%（95%CI 49.54-55.73），非高危组为 96.75%（95%CI 95.57-97.62）。高危组的 1 年幸存者的 COS 随时间有显著改善。高危组 5 年幸存者的 COS 没有差异。在高危组和非高危组中，分别有 82%和 32%的晚期死亡归因于癌症。晚期死亡的统计学显著不良预后因素为诊断时年龄≥1 岁、转移性疾病和非胸部原发病灶（P=0.001）。
COS 随时间的改善主要使高危患者受益，但与非高危患者相比，他们仍因癌症而面临更高的晚期死亡风险。年龄、分期和原发部位，但不是治疗年代，影响 5 年幸存者的结局。
