Childhood brain tumors in California
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1 Childhood brain tumors in California Danielle N. Rodriguez, MPH Eric Stewart, BA Cancer Registry of Greater California
2 Agenda Background Methods of Analysis Results Discussion Future Directions
3 Background Childhood cancers have been reported to be on the rise Primary brain tumors are the most common solid tumor and the second most common cancer in children after Leukemia 20% of all cancers Affects 2,500 children in the U.S. every year No definitive risk factors have been found Childhood tumors appear in different locations and behave differently from adult brain tumors
4 Background Cont. Since 2004, benign brain tumors have been consistently collected in registries. The most common brain tumors Medulloblastoma Astrocytoma Ependymomas Primitive neuroectodermal tumors Craniopharyngiomas Mixed glial and neuronal tumors Choroid plexus tumors Medulloblastoma
5 Purpose To explore incidence and survival for primary brain tumors (benign vs. malignant) in California children Determine if any differences are present in regards to malignancy among demographic characteristics. Analyze trends of malignant and benign brain tumors
6 Methods Study Inclusion Criteria Patients with primary brain tumors were identified through the California Cancer Registry (CCR) Population-based database that contains data on California residents diagnosed with any reportable cancer since 1988 Males and Females Children 19 years old Diagnosed Analyses including benign brain tumors only use years Malignant or benign brain tumor (Site Codes: C710-C719) Other CNS C700-C709, C720-C729 were not included in this study Resident of California at time of their diagnosis
7 Methods Cont. Data were analyzed using SEER*Stat and the Joinpoint Regression Program Incidence rates were calculated for both benign and malignant tumors Years: Trend analysis: primary endpoint in this analysis was the annual percent change (APC) Years: Survival: Two and Five year cause-specific survival analysis Malignant cancer only Years:
8 Results Distribution and Incidence Rates
9 Total Study Population N=3,221 cases of childhood brain tumors from Malignant 2,544 cases (79%) Benign 667 cases (21%) Total Malignant vs Non-Malignant 21% Total (n=3221) Malignant Benign 79%
10 Distribution: Age < 1 year years years years years 19% MALIGNANT 6% 26% BENIGN 6% 19% < 1 year years years years years 26% 21% 28% 27% 22%
11 Incidence: Age Incidence Rates (95% CI) Age Malignant Benign < 1 year old 3.20 ( ) 0.78 ( ) 1-4 years old 3.22 ( ) 0.63 ( ) 5-9 years old 2.87 ( ) 0.60 ( ) years old 2.00 ( ) 0.67 ( ) years old 1.81 ( ) 0.64 ( )
12 Distribution: Race/Ethnicity MALIGNANT Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander Other/Unknown 10% 2% 8% 3% BENIGN Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander Other/Unknown 39% 42% 43% 41% 6% 6%
13 Incidence: Race/Ethnicity Incidence Rates (95% CI) Race Malignant Benign NH White 3.09 ( ) 0.87 ( ) NH Black 2.08 ( ) 0.56 ( ) Hispanic 2.14 ( ) 0.53 ( ) NH Asian/PI 2.17 ( ) 0.43 ( )
14 Distribution: Sex # cases 2,000 1,800 1,600 1,400 1,200 1, Malignant Benign Total Male Female
15 Incidence: Sex Incidence Rates (95% CI) Sex Malignant Benign Males Females 2.67 ( ) 0.69 ( ) 2.26 ( ) 0.59 ( )
16 Distribution: SES Low Middle Low Middle Middle High High 19% MALIGNANT 22% 23% BENIGN 20% Low Middle Low Middle Middle High High 20% 16% 21% 21% 18% 20%
17 Incidence: SES Incidence Rates (95% CI) SES Malignant Benign Low 0.54 ( ) 0.13 ( ) Middle Low 0.52 ( ) 0.10 ( ) Middle 0.46 ( ) 0.12 ( ) Middle High 0.49 ( ) 0.13 ( ) High 0.46 ( ) 0.15 ( )
18 Distribution: Histology TOP MALIGNANT TOP BENIGN 15% 17% 30% 41% 20% 35% 20% Glioma Embryonal/Medulloblastoma Astrocytoma Pilocytic astrocytoma 22% Glioma Astrocytoma Neurofibroma Neuronal/Glial
19 Malignant brain tumors by site 3.6% 8.1% 8.03% 1.17% Cerebrum Ventricle 7.56% 27.8% Cerebellum Overlapping lesion: 4.9% Brain NOS: 8.61% 7.83% Brain stem 22.28%
20 Benign brain tumors by site 6.15% 8.85% 2.55% 2.1% Cerebrum 20.09% 9.45% Cerebellum Overlapping lesion: 10.04% Brain NOS: 15.14% Ventricle 21.44% Brain stem 4.2%
21 Results Cont. Trend Analysis
22 Trend Analysis: Age Malignant 4 Incidence Rates < 1 year olds 1-4 years old 5-9 years old years old years old Benign Year of Diagnosis Incidence Rates < 1 year olds 1-4 years old 5-9 years old years old years old *APC <1 year olds Benign: ^ for Year of Diagnosis
23 Trend Analysis: Race/Ethnicity Malignant Incidence Rates NH White NH Black Hispanic NH API Year of Diagnosis Benign 4 Incidence Rates NH White NH Black Hispanic NH API *APC NHW Benign: -5.17^ for APC NHB Malignant: 4.58^ for APC NHB Benign: for APC Hispanic Malignant: -2.04^ for Year of Diagnosis
24 Trend Analysis: Sex Malignant 3 Incidence Rates Year of Diagnosis Male Female Benign Incidence Rates Year of Diagnosis Male Female
25 Results Cont. Survival Analysis Overall Malignant Benign Alive 2,422 (75%) 1,781 (70%) 641 (96%) Deceased 799 (25%) 773 (30%) 26 (0.04%)
26 Survival Analysis: Overall (Malignant Only) 90.00% Overall 5-Year Survival 80.00% 70.00% Cause Specific Survival 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Year of Diagnosis
27 Survival Analysis: Age (Malignant Only) % 5-Year Suvival by Age % Cause Specific Survival 80.00% 60.00% 40.00% 20.00% 0.00% Year of Diagnosis < 1 Years Years Years Years Years
28 Survival Analysis: Race/Ethnicity (Malignant Only) 5-Year Survival by Race/Ethnicity % 90.00% Cause Specific Survival 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Year of Diagnosis Non-Hispanic White Non-Hispanic Black Hispanic Asian/Pacific Islander
29 Survival Analysis: Sex (Malignant Only) 5-Year Survival by Sex 90.00% 80.00% Cause Specific Survival 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Year of Diagnosis Male Female
30 Discussion No major difference for the distribution of benign and malignant cancer by age, sex, race, SES 1-4 year olds had the highest incidence rate for malignant, <1 year olds for benign Non-Hispanic Whites and Hispanics have the largest percentage of malignant and benign brain tumors Non-Hispanic White highest incidence rate Trend Analysis: Age: decreasing, most not significant < 1 year old statistically significant decrease in benign incidence rates Non-Hispanic whites showed a statistically significant decrease in benign Non-Hispanic black statistically significant increase in malignant Large increase in benign, but not statistically significant Survival: Two and five year survival has remained steady with some evidence of increased survival trends occurring.
31 Future Directions Conduct a trend test using joinpoint on the survival analysis results to detect any statistically significant increases and/or decreases in survival Conduct spatial analysis of childhood brain tumors (benign vs. malignant) Spatial clusters, distribution of cases Investigate birth characteristics in relationship to CA children with benign and malignant brain tumors Probabilistic record linkage to match cases from two data sources
32 Thank you! Danielle N. Rodriguez, MPH 1825 Bell Street Sacramento, CA Eric Stewart, BA 1825 Bell Street Sacramento, CA
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35 Trend Analysis: Histology 1 Malignant Only 0.25 Benign Only Incidence Rates Incidence Rates Year of Diagnosis Year of Diagnosis Glioma Embryonal/Medulloblastoma Astrocytoma Pilocytic Astrocytoma Glioma Astrocytoma Neurofibroma (B Only) Neuronal/Glia (B Only) Total 2 Most Common Histologies Joinpoint Results: Average Percent Change Histology Overall Malignant Benign Incidence Rates Year of Diagnosis Glioma Astrocytoma Glioma : : : Embryonal/ Medulloblastoma : : N/A Astrocytoma : : : Pilocytic Astrocytoma : : N/A : Neurofibroma : N/A : Neuronal/Glial : N/A : -1.08
36 Survival Analysis: Histology (Malignant Only) 2-Year Survival by Histology Cause Specific Survival % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Year of Diagnosis Glioma Embryonal/Medulloblastoma (Malig Only) Astrocytoma, NOS Pilocytic astrocytoma (Malig Only) 5-Year Survival by Histology Cause Specific Survival % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Year of Diagnosis Glioma Embryonal/Medulloblastoma (Malig Only) Astrocytoma, NOS Pilocytic astrocytoma (Malig Only)
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