Incidence and Outcomes of CNS Tumors in Chinese Children: Comparative Analysis With the Surveillance, Epidemiology, and End Results Program

Abstract

Purpose: Despite being the most common pediatric solid tumors, incidence and outcome of CNS tumors in Chinese children have not been systematically reported. We addressed this knowledge gap by comparing the epidemiology of pediatric CNS tumors in Hong Kong and the United States.

Patients and methods: Data between 1999 and 2016 from a population-based cancer registry in Hong Kong, China, on patients < 18 years old with CNS tumors (Hong Kong cohort) and from the US SEER Program (Asian/Pacific Islander and all ethnicities) were compared. Incidence and overall survival (OS) by histology were evaluated.

Results: During the study period, 526 children were newly diagnosed with CNS tumors in Hong Kong (crude incidence rate, 2.47 per 100,000; 95% CI, 2.26 to 2.69). Adjusted incidences were significantly lower in the Hong Kong (2.51; 95% CI, 2.30 to 2.74) than in the SEER (Asian/Pacific Islander: 3.26; 95% CI, 2.97 to 3.57; P < .001; all ethnicities: 4.10 per 100,000; 95% CI, 3.99 to 4.22; P < .001) cohorts. Incidences of germ cell tumors (0.57 v 0.24; P < .001) were significantly higher, but those of glial and neuronal tumors (0.94 v 2.61; P < .001), ependymomas (0.18 v 0.31; P = .005), and choroid plexus tumors (0.08 v 0.16; P = .045) were significantly lower in Hong Kong compared with SEER (all ethnicities) cohorts. Compared with the SEER (Asian/Pacific Islander) cohort, histology-specific incidences were similar except for a lower incidence of glial and neuronal tumors in Hong Kong (0.94 v 1.74; P < .001). Among cohorts, OS differed only for patients with glial and neuronal tumors (5-year OS: Hong Kong, 52.5%; SEER [Asian/Pacific Islander], 73.6%; SEER [all ethnicities], 79.9%; P < .001).

Conclusion: We identified important ethnic differences in the epidemiology of CNS tumors in Chinese children. These results will inform the development of pediatric neuro-oncology services in China and aid further etiologic studies.

FIG 1

Distribution of patients by (A) period of diagnosis, (B) sex, (C) diagnostic categories, and (D) WHO grading in the Hong Kong, SEER (Asians/Pacific Islanders), and SEER (all ethnicities) cohorts. CPT, choroid plexus tumor; GCT, germ cell tumor; NA, not available.

FIG 2

Sex- and study period–adjusted incidence of histologic groups by age in the (A) Hong Kong, (B) SEER (Asians/Pacific Islanders), and (C) SEER (all ethnicities) cohorts. CPT, choroid plexus tumor; GCT, germ cell tumor; y, years.

FIG 3

Five-year overall survival (OS) of patients in the Hong Kong cohort: (A) entire cohort and by (B) period of diagnosis, (C) age of diagnosis, (D) sex, (E) diagnostic categories, and (F) WHO grading. NA, not available.

FIG A1

Comparison of overall survival (OS) for patients from the Hong Kong (HK), SEER (Asians/Pacific Islanders [API]), and SEER (all ethnicities [all]) cohorts: (A) all entities, (B) glial and neuronal tumors, (C) choroid plexus tumors, (D) craniopharyngioma, (E) embryonal tumors, (F) ependymoma, and (G) germ cell tumors.

FIG A2

Comparison of overall survival (OS) of patients from the Hong Kong (HK), SEER (Asians/Pacific Islanders [API]), and SEER (all ethnicities [all]) cohorts by tumor subgroups: (A) medulloblastoma, (B) germinoma, (C) nongerminomatous germ cell tumors (NGGCTs), and (D) teratoma.