小児中枢神経系がんおよび神経芽細胞腫の生存率における不平等：人口ベース研究

Inequalities in adult cancer survival by sex, socio-economic position, and rural-urban residence are well established; however, evidence for childhood cancers, particularly site-specific survival, remains limited and inconsistent. This study investigated whether these inequalities exist among children diagnosed with central nervous system (CNS) cancers or neuroblastoma.

We conducted a population-based study using Victorian Cancer Registry data including 1324 children aged 0-14 years when diagnosed with CNS cancers (n = 933) or neuroblastoma (n = 391) in 1982-2021. Follow-up was conducted through linkage with death registries up to the end of 2021. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality in relation to sex, area-level socio-economic disadvantage, and remoteness of residence.

There was weak evidence of higher mortality in males than females for both CNS cancers (HR=1.16; 95 % CI: 0.96-1.41) and neuroblastoma (HR=1.29; 95 % CI: 0.92-1.80). Survival was poorer among children living in the most disadvantaged areas (highest quintile): 54 % higher mortality for CNS cancers (HR=1.54; 95 % CI: 1.09-2.18) and 89 % higher for neuroblastoma (HR=1.89; 95 % CI: 0.99-3.61) compared to those in the least disadvantaged areas (lowest quintile). Children with neuroblastoma living outside major cities had higher mortality (HR=1.43; 95 % CI: 1.01-2.02) than those in major cities, which was attenuated (HR=1.32; 95 % CI: 0.92-1.88) after adjustment for socio-economic disadvantage.

Children with CNS cancers and neuroblastoma living in socio-economically disadvantaged areas experienced poorer survival outcomes. There was weaker evidence for poorer survival in males and those living outside major cities. These findings underscore the need for targeted strategies to address survival inequalities in these childhood cancers.