title: Poor treatment outcome of neuroblastoma and other peripheral nerve cell tumors may be related to under usage of radiotherapy and socio-economic disparity: a US SEER data analysis.
abstract: OBJECTIVE
  This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) neuroblastoma (NB) and other peripheral nerve cell tumors (PNCT) outcome data. This study found under usage of radiotherapy in these patients.
  
  
  METHODS
  This study analyzed socio-economic, staging and treatment factors available in the SEER database for NB and other PNCT. For the risk modeling, each factor was fitted by a generalized jinear model to predict the outcome (soft tissue specific death, yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modeling errors. Risk of neuroendocrine (other endocrine including thymus as coded in SEER) death was computed for the predictors.
  
  
  RESULTS
  There were 5261 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 83.8 (97.6) months. The mean (SD) age was 18 (25) years. About 30.45% of patients were un-staged. The SEER staging has high ROC (SD) area of 0.58 (0.01) among the factors tested. We simplified the 4-layered risk levels (local, regional, distant, un-staged/others) to a simpler 3-tiered model with comparable ROC area of 0.59 (0.01). Less than 50% of PNCT patients received radiotherapy (RT) including the ones with localized disease. This avoidance of RT use occurred in adults and children.
  
  
  CONCLUSIONS
  The high under-staging rate may have prevented patients from selecting definitive radiotherapy (RT) after surgery. Using RT for, especially, adult PNCT patients is a potential way to improve outcome.
authors.affiliation: cheung.r100@gmail.com
authors.forename: Rex
authors.initials: R
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D012372:ROC Curve; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D018570:Risk Assessment; D018426:SEER Program / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult