The Association between Race and Survival among Pediatric Patients with Neuroblastoma in the US between 1973 and 2015

Background: Conclusive information regarding the influence of race on survival among neuroblastoma patients is limited. Our objective is to investigate the association between race and cause-specific survival in pediatric patients diagnosed with neuroblastoma in the US between 1973 and 2015. Methods: This was a retrospective cohort study using the Surveillance, Epidemiology, and End Result (SEER) database. Patients aged 17 and younger of black, white, or Asian Pacific Islander (API) race diagnosed with neuroblastoma from 1973-2015 were included (n = 2,119). The outcome variable was time from diagnosis to death. Covariates included age, gender, ethnicity, stage, tumor site, and year of diagnosis. Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals. Results: There were no statistically significant differences in the hazard of survival for blacks (HR 0.93; 95% confidence interval (CI) 0.74-1.16) or API (HR 1.02; 95% CI 0.76-1.37) compared with whites. However, patients diagnosed between 2000-2004 (HR 0.46; 95% CI 0.36-0.59) and 2005-2015 (HR 0.33; 95% CI 0.26-0.41) had decreased hazards of death when compared to patients treated during 1973 to 1999. Conclusions: No association between race and survival time was found. However, survival improved among all patients treated during 2000-2004 and 2005-2015 compared with those treated before the year 2000, leading to a narrowing of the racial disparity based on survival.