Comparison of Incidence and Outcomes of Neuroblastoma in Children, Adolescents, and Adults in the United States: A Surveillance, Epidemiology, and End Results (SEER) Program Population Study

Abstract

BACKGROUND This United States (U.S.) population study aimed to compare the incidence of neuroblastoma and outcomes in children, adolescents, and adults using the Surveillance, Epidemiology, and End Results (SEER) program database. MATERIAL AND METHODS Patients with neuroblastoma were identified in the SEER database from 1975 to 2013. According to the age at diagnosis, patients were divided into "Children" (≤14 years old) and "Adolescents/Adults" group (>14 years old). Then, comparisons in basic characteristics, incidence rates (IRs) and long-term survival outcomes between patients in 2 groups were made. RESULTS A total of 4280 patients were identified, including 3998 children and 282 adolescent/adult patients. Adolescent/adult patients were more likely to have localized diseases than children and to be diagnosed with ganglioneuroblastoma (all P<0.05). The IR of neuroblastoma presented with upward and downward trends in children and adolescent/adult populations, respectively. Adolescents/adults had worse overall survival (OS) than children despite the earlier tumor stage. Lastly, multivariate Cox proportional hazards analyses showed that tumor stage, histology, sequence of primary malignancy, primary site, the administration of surgery, and treatment era were prognostic factors for children, and sequence of primary malignancy, primary site, undergoing surgery, and treatment era were tightly related to OS in adolescent/adult patients. CONCLUSIONS Analysis of the SEER program database between 1975 to 2013 showed that in the U.S., the incidence of neuroblastoma in children increased, but the incidence decreased in adolescents and adults. There was a trend for improved overall survival in all age groups despite the increased stage at presentation in children.

Figure 1

Evolution of the incidence rates of neuroblastoma by period and age group in the Surveillance, Epidemiology and End Results Program database from 1975 to 2013.

Figure 2

Annual percentage change curves (incidence rate, per 100 000 person-years) for different populations: the general population (A), children (B), adolescents/adults (C). * Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha=0.05 level. Final Selected Model: 0 Joinpoints.

Figure 3

Kaplan-Meier curves of overall survival (A–F) and cancer-specific survival (G–L) for neuroblastoma patients, stratified by year of diagnosis (A, G), stage (B, H), histology (C, I), primary site (D, J), sex (E, K), and the administration of surgery (C, L).

Figure 4

Kaplan-Meier curves of overall survival (A) and cancer-specific survival (B) for the 3998 children with neuroblastoma compared with the 282 adolescents/adults with neuroblastoma.

Figure 5

Kaplan-Meier curves of overall survival for all patients, stratified by age at diagnosis (A), and the 5- and 10-year survival probabilities by age group (B).

Figure 6

Kaplan-Meier curves of overall survival for adolescents/adults and children with neuroblastoma, stratified by different variables: sex (A, B), race (C–E), stage (F–H), place of residence (I, J), histology (K, L), median household income (M, N), and the administration of surgery (O, P).

Figure 7

Kaplan-Meier curves of cancer-specific survival for adolescents/adults and children with neuroblastoma, stratified by different variables: sex (A, B), race (C–E), stage (F–H), place of residence (I, J), histology (K, L), median household income (M, N), and the administration of surgery (O, P).