Persistence of Racial and Ethnic Disparities in Risk and Survival for Patients with Neuroblastoma over Two Decades.

Background: Racial/ethnic survival disparities in neuroblastoma were first reported more than a decade ago. We sought to investigate if these disparities have persisted with current era therapy.
Methods: Two patient cohorts were identified in the International Neuroblastoma Risk Group Data Commons (INRGdc) (Cohort 1: diagnosed 2001-2009, n=4359; Cohort 2: diagnosed 2010-2019, n=4891). Chi-squared tests were used to assess the relationship between race/ethnicity and clinical and biologic features. Survival was estimated by the Kaplan-Meier method. Cox proportional hazards regression analyses were performed to investigate the association between racial/ethnic groups and prognostic markers.
Results: Significantly higher 5-year event-free survival (EFS) and overall survival (OS) were observed for Cohort 2 compared to Cohort 1 (P<0.001 and P<0.001, respectively). Compared to White patients, Black patients in both cohorts had a higher proportion of high-risk disease (Cohort 1: P<0.001; Cohort 2: P<0.001) and worse EFS (Cohort 1: P<0.001; Cohort 2 P<0.001) and OS (Cohort 1: P<0.001; Cohort 2: P<0.001). In Cohort 1, Native Americans also had a higher proportion of high-risk disease (P=0.03) and inferior EFS/OS. No significant survival disparities were observed for low- or intermediate-risk patients in either cohort or high-risk patients in Cohort 1. Hispanic patients with high-risk disease in Cohort 2 had significantly inferior OS (P=0.047). Significantly worse OS, but not EFS, (P=0.006 and P=0.02, respectively) was also observed among Black and Hispanic patients assigned to receive post-Consolidation dinutuximab on clinical trials (n=885).
Conclusion: Racial/ethnic survival disparities have persisted over time and were observed among high-risk patients assigned to receive post-Consolidation dinutuximab.
Competing Interests: Conflict of Interest/Financial Disclosures: Mark A. Applebaum: consultancy fees from Illumina Radiopharmaceuticals. Arlene Naranjo: serves on a DSMC for Novartis. Sam L. Volchenboum: Founder of Litmus Health, Inc. Tara O. Henderson: research funding from Seattle Genetics. Susan L. Cohn: stock ownership in Pfizer, Merck, and Lilly; served on advisory boards for Y-mAbs Therapeutics and US World Meds. Ami V. Desai: stock ownership in Pfizer and Viatris; consultancy/advisory board fees from Ology Medical Education, YMabs Therapeutics, Glaxo Smith-Kline; travel/accommodation expenses from YMabs Therapeutics. The remaining authors made no disclosures.