Space-time clustering of childhood central nervous system tumours in Yorkshire, UK

<p>Abstract</p> <p>Background</p> <p>We specifically tested the aetiological hypothesis that a factor influencing geographical or temporal heterogeneity of childhood central nervous system (CNS) tumour incidence was related to exposure to a transient environmental agent.</p> <p>Methods</p> <p>Information was extracted on individuals aged 0-14 years, diagnosed with a CNS tumour between the 1st January 1974 and 31st December 2006 from the Yorkshire Specialist Register of Cancer in Children and Young People. Ordnance Survey eight-digit grid references were allocated to each case with respect to addresses at the time of birth and the time of diagnosis, locating each address to within 0.1 km. The following diagnostic groups were specified <it>a priori </it>for analysis: ependymoma; astrocytoma; primitive neuroectodermal tumours (PNETs); other gliomas; total CNS tumours. We applied the <it>K</it>-function method for testing global space-time clustering using fixed geographical distance thresholds. Tests were repeated using variable nearest neighbour (NN) thresholds.</p> <p>Results</p> <p>There was statistically significant global space-time clustering for PNETs only, based on time and place of diagnosis (<it>P </it>= 0.03 and 0.01 using the fixed geographical distance and the variable NN threshold versions of the <it>K</it>-function method respectively).</p> <p>Conclusions</p> <p>There was some evidence for a transient environmental component to the aetiology of PNETs. However, a possible role for chance cannot be excluded.</p

Sex-specific incidence and temporal trends in solid tumours in young people from Northern England, 1968–2005

<p>Abstract</p> <p>Background</p> <p>This study examined sex-specific patterns and temporal trends in the incidence of solid tumours in the Northern Region of England from 1968 to 2005. This updates earlier analyses from the region where sex was not considered in depth. Sex-specific analyses were carried out to determine whether sex differences might provide clues to aetiology.</p> <p>Methods</p> <p>Details of 3576 cases, aged 0–24 years, were obtained from a specialist population-based cancer registry. There were 1843 males (886 aged 0–14 years and 957 aged 15–24 years) and 1733 females (791 aged 0–14 years and 942 aged 15–24 years). Age-standardized incidence rates (per million population) were calculated. Linear regression was used to analyze temporal trends in incidence and annual percentage changes were estimated. Analyses were stratified by sex and by age-group.</p> <p>Results</p> <p>There were marked differences in incidence patterns and trends between males and females and also between age-groups. For males central nervous system (CNS) tumours formed the largest proportion of under-15 cases and germ cell tumours was the largest group in the 15–24's, whilst for females CNS tumours dominated in the under-15's and carcinomas in the older group. For 0–14 year olds there were male-specific increases in the incidence of rhabdomyosarcoma (2.4% per annum; 95% CI: 0.2%–4.5%) and non-melanotic skin cancer (9.6%; 95% CI: 0.0%–19.2%) and female-specific increases for sympathetic nervous system tumours (2.2%; 95% CI: 0.4%–3.9%), gonadal germ cell tumours (8.6%; 95% CI: 4.3%–12.9%) and non-gonadal germ cell tumours (5.4%; 95% CI: 2.8%–7.9%). For 15–24 year olds, there were male-specific increases in gonadal germ cell tumours (1.9%; 95% CI: 0.3%–3.4%), non-gonadal germ cell tumours (4.4%; 95% CI: 1.1%–7.7%) and non-melanotic skin cancer (4.7%; 95% CI: 0.5%–8.9%) and female-specific increases for osteosarcoma (3.5%; 95% CI: 0.5%–6.5%), thyroid cancer (2.8%; 95% CI: 0.1%–5.6%) and melanoma (4.6%; 95% CI: 2.2%–7.1%).</p> <p>Conclusion</p> <p>This study has highlighted notable differences between the sexes in incidence patterns and trends for solid tumours. Some of these sex-specific differences could have been obscured if males and females had been analysed together. Furthermore, they suggest aetiological differences or differential susceptibility to environmental factors between males and females.</p

Factors associated with recurrence and survival length following relapse in patients with neuroblastoma

Background: Despite therapeutic advances, survival following relapse for neuroblastoma patients remains poor. We investigated clinical and biological factors associated with length of progression-free and overall survival following relapse in UK neuroblastoma patients. Methods: All cases of relapsed neuroblastoma, diagnosed during 1990-2010, were identified from four Paediatric Oncology principal treatment centres. Kaplan-Meier and Cox regression analyses were used to calculate post-relapse overall survival (PROS), post-relapse progression-free survival (PRPFS) between relapse and further progression, and to investigate influencing factors. Results: One hundred eighty-nine cases were identified from case notes, 159 (84.0%) high risk and 17 (9.0%), unresectable, MYCN non-amplified (non-MNA) intermediate risk (IR). For high-risk patients diagnosed >2000, median PROS was 8.4 months (interquartile range (IQR)=3.0-17.4) and median PRPFS was 4.7 months (IQR=2.1-7.1). For IR, unresectable non-MNA patients, median PROS was 11.8 months (IQR 9.0-51.6) and 5-year PROS was 24% (95% CI 7-45%). MYCN amplified (MNA) disease and bone marrow metastases at diagnosis were independently associated with worse PROS for high-risk cases. Eighty percent of high-risk relapses occurred within 2 years of diagnosis compared with 50% of unresectable non-MNA IR disease. Conclusions: Patients with relapsed HR neuroblastomas should be treatment stratified according to MYCN status and PRPFS should be the primary endpoint in early phase clinical trials. The failure to salvage the majority of IR neuroblastoma is concerning, supporting investigation of intensification of upfront treatment regimens in this group to determine whether their use would diminish likelihood of relapse

Do cardiometabolic, behavioural and socioeconomic factors explain the 'healthy migrant effect' in the UK? Linked mortality follow-up of South Asians compared with white Europeans in the Newcastle Heart Project.

BACKGROUND: Immigrants are sometimes found to have better health than locally born populations. We examined the mortality experience of South Asian origin and white European origin individuals living in Newcastle upon Tyne, UK. METHODS: A linked 17-21 year mortality follow-up of a cross-sectional study of European (n=825) and South Asian (n=709) men and women, aged 25-74 years, recruited between 1993 and 1997. Poisson regression was used to estimate mortality rate ratios (MRRs) for all-cause mortality. Sensitivity analysis explored the possible effect of differences between ethnic groups in loss to follow-up. The impact of adjustment for established risk factors on MRRs was studied. RESULTS: South Asians had lower all-cause age-adjusted and sex-adjusted mortality than Europeans (MRR 0.70; 95% CI 0.58 to 0.85). There was higher loss to follow-up in South Asians. Sensitivity analyses demonstrated that this did not account for the observed lower mortality. Adjustment for cardiometabolic, behavioural and socioeconomic characteristics attenuated but did not eliminate the mortality differences between South Asians and Europeans, although CIs now cross 1 (MRR 0.79; 95% CI 0.55 to 1.13). CONCLUSIONS: South Asians had lower all-cause mortality compared with European origin individuals living in Newcastle upon Tyne that were not accounted for by incomplete mortality data. It is possible that such migrants to the UK have the resources and motivation to move in search of better opportunities and may be healthier and wealthier than those who remain in their country of origin. These findings challenge us to better understand and measure the factors contributing to their survival advantage