title: Divergent Patterns of Incidence in Peripheral Neuroblastic Tumors.
abstract: BACKGROUND
  Prior research on trends in neuroblastoma incidence has conflicted. We aimed to compare how ganglioneuroblastoma and neuroblastoma incidence have changed.
  
  
  METHODS
  Using the Surveillance Epidemiology and End Results (SEER) 9 population-based registry, we identified 2081 malignant peripheral neuroblastic tumors in patients 0 to 14 years from 1973 to 2009. Age-adjusted annual incidence rates were calculated using SEER*Stat, and Joinpoint Regression Program was used to calculate annual percent change (APC) and analyze trends. Data were stratified by histology, age, and stage.
  
  
  RESULTS
  Overall peripheral neuroblastic tumor incidence increased by an APC of 0.47 (P=0.045). However, ganglioneuroblastoma incidence decreased (APC=-1.48; P=0.003), whereas neuroblastoma incidence increased (APC=0.79; P=0.008). When divided by age and stage, locoregional neuroblastoma incidence increased in infants until a significant inflection point in 1996 (APC=4.19; P<0.001) and then decreased sharply (APC=-6.80; P=0.160).
  
  
  CONCLUSIONS
  Ganglioneuroblastoma incidence has decreased, whereas neuroblastoma incidence has increased. These changes could be real, or reflect bias from classification changes or increased detection. Neuroblastoma incidence increased most markedly in infants with locoregional disease only until 1996, then declined, which may reflect changes in tumor ascertainment and folate supplementation.
authors.affiliation: *Stanford University School of Medicine †Departments of Neurology, Pediatrics, Neurosurgery, and Human Biology ‡Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Stanford University, Stanford, CA.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Merrihew
authors.forename: Paul G
authors.initials: PG
authors.lastname: Fisher
authors.forename: Karen E
authors.initials: KE
authors.lastname: Effinger
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D018305:Ganglioneuroblastoma / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009447:Neuroblastoma / Q000453:epidemiology*; D018426:SEER Program