The development and initial evaluation of referral flowchart for suspected neuroblastoma for pediatricians in nononcology clinics in China

Abstract

Background The delayed diagnosis of neuroblastoma (NB) is common in China, which results in the prognosis of NB in China lagging behind that in developed countries. Methods A referral flowchart for suspected NB was implemented in nononcology clinics at Beijing Children's Hospital (BCH). Patients with symptoms of suspected NB were referred from nononcology clinics in BCH to oncology clinics and confirmed NB cases were regarded as referral group. The control group comprised patients initially diagnosed with NB who came directly to oncology clinics in BCH from other regions nationwide. The age at NB diagnosis was compared as primary outcome, and the 5‐year overall survival (OS) and event‐free survival (EFS) were compared via the Kaplan‐Meier method and log‐rank tests. Results In total, 3337 children with suspected NB were screened consecutively from 687 070 pediatric patients. Through examination of urine vanillylmandelic acid and homovanillic acid, or B‐ultrasound, 102 of 3337 patients were referred to oncologists for comprehensive evaluations. Eventually, 29 referred patients were diagnosed as NB and the hospital‐based diagnosis rate of NB was 4.2 per 100 000 visits. The median age at diagnosis in the referral group was 21.0 months, which was 9 months earlier than that of the control group (30.0 months, P = .026). The 5‐year OS rate was 72.4% in the referral group, which was higher than that of the control group (66.7%) but without statistical significance (P = .664). Conclusion Delayed NB detection could be avoided by training pediatricians in nononcology clinics to detect suspected NB and refer these patients to oncologists.

Impact of the COVID-19 pandemic on the demographic and disease burden of pediatric malignant solid tumors in China: a single-center, cross-sectional study

“…The stage of NB was determined according to International Neuroblastoma Risk Group Staging System (INRGSS) criteria ( 14 ). Patients with NB were treated according to the NB protocol of BCH (BCH-NB-2007), which was developed based on Hong Kong NB Protocol 7 and the European Low and Intermediate-Risk (IR) NB protocol ( 15 ). The staging criteria for RMS adopted the postoperative pathological clinical grouping system of the Intergroup RMS study (IRS) in the United States combined with the clinical staging system [Tumor Node Metastasis-Union for International Cancer Control (TNM-UICC)] developed by the International Society of Paediatric Oncology (SIOP) based on pretreatment imaging ( 16 ).…”