Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 3;8(2):e2458531.
doi: 10.1001/jamanetworkopen.2024.58531.

Racial and Ethnic Survival Disparities Among Children With High-Risk Neuroblastoma: A Children's Oncology Group Report

Puja J Umaretiya  1   2 , Arlene Naranjo  3 , Fan F Zhang  4 , Julie R Park  5 , Brian D Weiss  6 , Meaghan Granger  5 , Ami V Desai  7 , M Fevzi Ozkaynak  8 , Alice L Yu  9   10 , Rahela Aziz-Bose  11   12   13   14 , Sandi L Pruitt  2   15 , Steven G DuBois  11   12   13 , Rochelle Bagatell  16 , Kira Bona  11   12   13   14
Affiliations

Racial and Ethnic Survival Disparities Among Children With High-Risk Neuroblastoma: A Children's Oncology Group Report

Puja J Umaretiya et al. JAMA Netw Open. .

Abstract

Importance: Whether population-based racial and ethnic survival disparities for children with high-risk neuroblastoma persist in the clinical trial setting is unknown.

Objective: To investigate racial and ethnic survival disparities among children with high-risk neuroblastoma treated on frontline clinical trials.

Design, setting, and participants: This retrospective cohort study used data from Children's Oncology Group (COG) high-risk neuroblastoma trials from January 1, 2007, to December 31, 2016, with a data freeze on June 30, 2021. Children with high-risk neuroblastoma were analyzed in 2 cohorts: induction/consolidation trial participants and post-consolidation trial participants. Statistical analyses were performed from September 2, 2021, to December 30, 2024.

Exposures: Race and ethnicity were the primary exposures, categorized as Hispanic, non-Hispanic Black, non-Hispanic other (American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander), or non-Hispanic White.

Main outcomes and measures: Primary outcomes included overall survival (OS) and event-free survival (EFS) from time of trial enrollment, estimated by Kaplan-Meier methods. Associations with race and ethnicity were evaluated by log-rank tests and Cox proportional hazards regression models. Secondary outcomes included induction delays, early trial withdrawal, relapse as first event, death as first event, postrelapse OS, and early phase trial enrollment.

Results: The induction/consolidation cohort (median follow-up, 8.3 years [IQR, 6.1-9.8 years]) included 696 patients (404 males [58.1%]; 79 Hispanic patients [11.4%], 109 non-Hispanic Black patients [15.7%], 27 patients of non-Hispanic other race [3.9%], and 481 non-Hispanic White patients [69.1%]). The post-consolidation cohort (median follow-up, 7.5 years [IQR, 5.8-9.4 years]) included 935 patients (567 males [60.6%]; 87 Hispanic patients [9.3%], 145 non-Hispanic Black patients [15.5%], 41 patients of non-Hispanic other race [4.4%], and 662 non-Hispanic White patients [70.8%]). In multivariable Cox proportional hazards regression models, Hispanic children experienced significantly inferior OS (hazard ratio [HR], 1.78; 95% CI, 1.25-2.53; P = .01) on induction/consolidation studies compared with non-Hispanic White children; EFS did not differ. Non-Hispanic Black (HR, 1.54; 95% CI, 1.13-2.11) and Hispanic children (HR, 1.63; 95% CI, 1.09-2.43) experienced inferior OS on post-consolidation studies compared with non-Hispanic White children (P = .009); Hispanic children in post-consolidation studies experienced inferior EFS (HR, 1.68; 95% CI, 1.14-2.47; P = .02). Death as first event and postrelapse OS also differed by race and ethnicity.

Conclusions and relevance: This study suggests that Black and Hispanic children with high-risk neuroblastoma experienced inferior OS despite uniform planned treatment on frontline COG clinical trials. Investigated mechanisms did not completely explain survival disparities. Future evaluation of disparate treatment-related toxicities and postrelapse care as explanatory mechanisms are key next steps to promote equity.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Umaretiya reported receiving the Conquer Cancer Young Investigator Award during the conduct of the study. Dr Naranjo reported receiving personal fees from Novartis outside the submitted work. Dr Desai reported owning stock in Pfizer and Viatris; receiving personal fees from YMabs, GlaxoSmithKline, Recordati, and the US Food and Drug Administration; and having an institutional clinical trial contract with Merck, Roche, Jubilant DraxImage, YMabs, Lilly, GlaxoSmithKline, and Actuate Therapeutics outside the submitted work. Dr Pruitt reported receiving personal fees from Pfizer and Gilead outside the submitted work. Dr DuBois reported receiving personal fees from Amgen, Bayer, Jazz, and InhibRx outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Flow Diagram for Analytic Cohorts
Figure 2.
Figure 2.. Survival Curves for Induction/Consolidation Cohort, Post-Consolidation Cohort, and Relapse Cohort by Race and Ethnicity
A, Event-free survival (EFS) in induction/consolidation cohort from time of enrollment at initial diagnosis. B, Overall survival (OS) in induction/consolidation cohort from time of enrollment at initial diagnosis. C, Post-consolidation EFS from time of enrollment at start of post-consolidation. D, Post-consolidation OS from time of enrollment at start of post-consolidation. E, Overall survival from time of first relapse.
See this image and copyright information in PMC

References

    1. Goggins WB, Lo FF. Racial and ethnic disparities in survival of US children with acute lymphoblastic leukemia: evidence from the SEER database 1988-2008. Cancer Causes Control. 2012;23(5):737-743. doi:10.1007/s10552-012-9943-8 - DOI - PubMed
    1. Hossain MJ, Xie L, Caywood EH. Prognostic factors of childhood and adolescent acute myeloid leukemia (AML) survival: evidence from four decades of US population data. Cancer Epidemiol. 2015;39(5):720-726. doi:10.1016/j.canep.2015.06.009 - DOI - PMC - PubMed
    1. Henderson TO, Bhatia S, Pinto N, et al. . Racial and ethnic disparities in risk and survival in children with neuroblastoma: a Children’s Oncology Group study. J Clin Oncol. 2011;29(1):76-82. doi:10.1200/JCO.2010.29.6103 - DOI - PMC - PubMed
    1. Kahn JM, Kelly KM, Pei Q, et al. . Survival by Race and ethnicity in pediatric and adolescent patients with Hodgkin lymphoma: a Children’s Oncology Group study. J Clin Oncol. 2019;37(32):3009-3017. doi:10.1200/JCO.19.00812 - DOI - PMC - PubMed
    1. Bhatia S. Disparities in cancer outcomes: lessons learned from children with cancer. Pediatr Blood Cancer. 2011;56(6):994-1002. doi:10.1002/pbc.23078 - DOI - PMC - PubMed

Publication types