Abstract
Background: The potential impact of diagnostic delays on patients' outcomes is a debated issue in pediatric oncology and discordant results have been published so far. We attempted to tackle this issue by analyzing a prospective series of 351 consecutive children and adolescents with solid malignancies using innovative statistical tools. Methods: To address the nonlinear complexity of the association between symptom interval and overall survival (OS), a regression tree algorithm was constructed with sequential binary splitting rules and used to identify homogeneous patient groups vis-à-vis functional relationship between diagnostic delay and OS. Results: Three different groups were identified: group A, with localized disease and good prognosis (5-year OS 85.4%); group B, with locally or regionally advanced, or metastatic disease and intermediate prognosis (5-year OS 72.9%), including neuroblastoma, Wilms tumor, nonrhabdomyosarcoma soft tissue sarcoma, and germ cell tumor and group C, with locally or regionally advanced, or metastatic disease and poor prognosis (5-year OS 45%), including brain tumors, rhabdomyosarcoma, and bone sarcoma. The functional relationship between symptom interval and mortality risk differed between the three subgroups, there being no association in group A (hazard ratio [HR]: 0.96), a positive linear association in group B (HR: 1.48), and a negative linear association in group C (HR: 0.61). Conclusions: Our analysis suggests that at least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays. Based on these findings, early diagnosis should remain a goal for pediatric cancer patients.
| Original language | English |
|---|---|
| Pages (from-to) | 479-485 |
| Number of pages | 7 |
| Journal | Pediatric Blood and Cancer |
| Volume | 63 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 1 2016 |
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Keywords
- Adolescents
- Cancer
- Children
- Diagnostic delay
- Outcome
- Symptom interval
ASJC Scopus subject areas
- Oncology
- Pediatrics, Perinatology, and Child Health
- Hematology
Cite this
The Sooner the Better? How Symptom Interval Correlates With Outcome in Children and Adolescents With Solid Tumors : Regression Tree Analysis of the Findings of a Prospective Study. / Ferrari, Andrea; Lo Vullo, Salvatore; Giardiello, Daniele; Veneroni, Laura; Magni, Chiara; Clerici, Carlo Alfredo; Chiaravalli, Stefano; Casanova, Michela; Luksch, Roberto; Terenziani, Monica; Spreafico, Filippo; Meazza, Cristina; Catania, Serena; Schiavello, Elisabetta; Biassoni, Veronica; Podda, Marta; Bergamaschi, Luca; Puma, Nadia; Massimino, Maura; Mariani, Luigi.
In: Pediatric Blood and Cancer, Vol. 63, No. 3, 01.03.2016, p. 479-485.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The Sooner the Better? How Symptom Interval Correlates With Outcome in Children and Adolescents With Solid Tumors
T2 - Regression Tree Analysis of the Findings of a Prospective Study
AU - Ferrari, Andrea
AU - Lo Vullo, Salvatore
AU - Giardiello, Daniele
AU - Veneroni, Laura
AU - Magni, Chiara
AU - Clerici, Carlo Alfredo
AU - Chiaravalli, Stefano
AU - Casanova, Michela
AU - Luksch, Roberto
AU - Terenziani, Monica
AU - Spreafico, Filippo
AU - Meazza, Cristina
AU - Catania, Serena
AU - Schiavello, Elisabetta
AU - Biassoni, Veronica
AU - Podda, Marta
AU - Bergamaschi, Luca
AU - Puma, Nadia
AU - Massimino, Maura
AU - Mariani, Luigi
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background: The potential impact of diagnostic delays on patients' outcomes is a debated issue in pediatric oncology and discordant results have been published so far. We attempted to tackle this issue by analyzing a prospective series of 351 consecutive children and adolescents with solid malignancies using innovative statistical tools. Methods: To address the nonlinear complexity of the association between symptom interval and overall survival (OS), a regression tree algorithm was constructed with sequential binary splitting rules and used to identify homogeneous patient groups vis-à-vis functional relationship between diagnostic delay and OS. Results: Three different groups were identified: group A, with localized disease and good prognosis (5-year OS 85.4%); group B, with locally or regionally advanced, or metastatic disease and intermediate prognosis (5-year OS 72.9%), including neuroblastoma, Wilms tumor, nonrhabdomyosarcoma soft tissue sarcoma, and germ cell tumor and group C, with locally or regionally advanced, or metastatic disease and poor prognosis (5-year OS 45%), including brain tumors, rhabdomyosarcoma, and bone sarcoma. The functional relationship between symptom interval and mortality risk differed between the three subgroups, there being no association in group A (hazard ratio [HR]: 0.96), a positive linear association in group B (HR: 1.48), and a negative linear association in group C (HR: 0.61). Conclusions: Our analysis suggests that at least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays. Based on these findings, early diagnosis should remain a goal for pediatric cancer patients.
AB - Background: The potential impact of diagnostic delays on patients' outcomes is a debated issue in pediatric oncology and discordant results have been published so far. We attempted to tackle this issue by analyzing a prospective series of 351 consecutive children and adolescents with solid malignancies using innovative statistical tools. Methods: To address the nonlinear complexity of the association between symptom interval and overall survival (OS), a regression tree algorithm was constructed with sequential binary splitting rules and used to identify homogeneous patient groups vis-à-vis functional relationship between diagnostic delay and OS. Results: Three different groups were identified: group A, with localized disease and good prognosis (5-year OS 85.4%); group B, with locally or regionally advanced, or metastatic disease and intermediate prognosis (5-year OS 72.9%), including neuroblastoma, Wilms tumor, nonrhabdomyosarcoma soft tissue sarcoma, and germ cell tumor and group C, with locally or regionally advanced, or metastatic disease and poor prognosis (5-year OS 45%), including brain tumors, rhabdomyosarcoma, and bone sarcoma. The functional relationship between symptom interval and mortality risk differed between the three subgroups, there being no association in group A (hazard ratio [HR]: 0.96), a positive linear association in group B (HR: 1.48), and a negative linear association in group C (HR: 0.61). Conclusions: Our analysis suggests that at least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays. Based on these findings, early diagnosis should remain a goal for pediatric cancer patients.
KW - Adolescents
KW - Cancer
KW - Children
KW - Diagnostic delay
KW - Outcome
KW - Symptom interval
UR - http://www.scopus.com/inward/record.url?scp=84955324257&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84955324257&partnerID=8YFLogxK
U2 - 10.1002/pbc.25833
DO - 10.1002/pbc.25833
M3 - Article
VL - 63
SP - 479
EP - 485
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
SN - 1545-5009
IS - 3
ER -