Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, National Center for Children's Health, Key Laboratory of Major Diseases in Children, Ministry of Education, Capital Medical University, Beijing, China.
Pediatr Blood Cancer. 2021 May;68(5):e28869. doi: 10.1002/pbc.28869. Epub 2020 Dec 31.
The delayed diagnosis of neuroblastoma (NB) is common in China, which results in the prognosis of NB in China lagging behind that in developed countries.
A referral flowchart for suspected NB was implemented in nononcology clinics at Beijing Children's Hospital (BCH). Patients with symptoms of suspected NB were referred from nononcology clinics in BCH to oncology clinics and confirmed NB cases were regarded as referral group. The control group comprised patients initially diagnosed with NB who came directly to oncology clinics in BCH from other regions nationwide. The age at NB diagnosis was compared as primary outcome, and the 5-year overall survival (OS) and event-free survival (EFS) were compared via the Kaplan-Meier method and log-rank tests.
In total, 3337 children with suspected NB were screened consecutively from 687 070 pediatric patients. Through examination of urine vanillylmandelic acid and homovanillic acid, or B-ultrasound, 102 of 3337 patients were referred to oncologists for comprehensive evaluations. Eventually, 29 referred patients were diagnosed as NB and the hospital-based diagnosis rate of NB was 4.2 per 100 000 visits. The median age at diagnosis in the referral group was 21.0 months, which was 9 months earlier than that of the control group (30.0 months, P = .026). The 5-year OS rate was 72.4% in the referral group, which was higher than that of the control group (66.7%) but without statistical significance (P = .664).
Delayed NB detection could be avoided by training pediatricians in nononcology clinics to detect suspected NB and refer these patients to oncologists.
神经母细胞瘤（NB）在中国的诊断常常被延误，这导致中国 NB 的预后落后于发达国家。
在北京儿童医院（BCH）的非肿瘤科门诊实施了疑似 NB 的转诊流程图。来自 BCH 非肿瘤科的有疑似 NB 症状的患者被转诊到肿瘤科，并将确诊的 NB 病例视为转诊组。对照组包括最初直接从全国其他地区的肿瘤科就诊的初诊为 NB 的患者。NB 诊断时的年龄为主要结局进行比较，并通过 Kaplan-Meier 方法和对数秩检验比较 5 年总生存率（OS）和无事件生存率（EFS）。
共连续筛查了 687070 例儿科患者中的 3337 例疑似 NB 儿童。通过尿液香草基扁桃酸和高香草酸或 B 超检查，3337 例患者中有 102 例被转介给肿瘤医生进行综合评估。最终，29 例转诊患者被诊断为 NB，NB 的医院诊断率为每 100000 次就诊 4.2 例。转诊组的中位诊断年龄为 21.0 个月，比对照组（30.0 个月）早 9 个月（P=0.026）。转诊组的 5 年 OS 率为 72.4%，高于对照组（66.7%），但无统计学意义（P=0.664）。
通过培训非肿瘤科的儿科医生来检测疑似 NB 并将这些患者转介给肿瘤医生，可以避免 NB 检测延迟。
