Birth-related characteristics, congenital malformation, maternal reproductive history and neuroblastoma: the ESCALE study (SFCE)

The association between birth weight and the risk of neuroblastoma: a meta-analysis of observational studies involving 4,361,141 participants

One of the most common extracranial solid tumors in childhood is neuroblastoma. In this study, it was aimed to perform a systematic review and meta-analysis to evaluate the risk of neuroblastoma in both high and low birth weights. The PRISMA and MOOSE guidelines were followed during the design, analysis, and reporting of this study. A comprehensive literature search was undertaken for the published papers in Embase, PubMed/Medline, Scopus, and the Web of Science (WoS) databases. The odds ratio (OR) of neuroblastoma in high and low birth weight groups, with 95% confidence intervals (CIs), were calculated using the random-effects and fixed-effects models. A total of 16 papers and 4,361,141 participants were included in this study. When the random-effects model and the fixed-effects model were used, high birth weight was associated with an increased risk of neuroblastoma (OR = 1.17; 95% CI: 1.06-1.29, P = 0.002; heterogeneity: Chi2 = 2.33, df = 15, I2 = 0%, P>0.05). Similarly, it was observed that individuals with low birth weights may also face an increased risk of developing neuroblastoma later in life (OR = 1.19; 95% CI: 1.03-1.37, P = 0.017; heterogeneity: Chi2 = 16.93, df = 15, I2 = 0%, P = 0.323). In conclusion, both high and low birth weight in individuals may be among the important risk factors for neuroblastoma development.

NONO enhances mRNA processing of super-enhancer-associated GATA2 and HAND2 genes in neuroblastoma

High-risk neuroblastoma patients have poor survival rates and require better therapeutic options. High expression of a multifunctional DNA and RNA-binding protein, NONO, in neuroblastoma is associated with poor patient outcome; however, there is little understanding of the mechanism of NONO-dependent oncogenic gene regulatory activity in neuroblastoma. Here, we used cell imaging, biochemical and genome-wide molecular analysis to reveal complex NONO-dependent regulation of gene expression. NONO forms RNA- and DNA-tethered condensates throughout the nucleus and undergoes phase separation in vitro, modulated by nucleic acid binding. CLIP analyses show that NONO mainly binds to the 5' end of pre-mRNAs and modulates pre-mRNA processing, dependent on its RNA-binding activity. NONO regulates super-enhancer-associated genes, including HAND2 and GATA2. Abrogating NONO RNA binding, or phase separation activity, results in decreased expression of HAND2 and GATA2. Thus, future development of agents that target RNA-binding activity of NONO may have therapeutic potential in this cancer context.

Maternal Medication Use and Childhood Cancer in Offspring-Systematic Review and Considerations for Researchers

Cancer is an important cause of childhood mortality, yet the etiology is largely unknown. A combination of pre- and postnatal factors is thought to be implicated, including maternal medication use. We aimed to provide: 1) a systematic review of peer-reviewed publications on associations between maternal medication use and childhood cancer, with a focus on study design and methodology; and 2) suggestions for how to increase transparency, limit potential biases, and improve comparability in studies on maternal medication use and childhood cancer. We conducted a systematic search in the PubMed, Embase, Scopus, Cochrane, and Web of Science databases to June 8, 2020. Altogether, 112 studies were identified. The reviewed studies were heterogeneous in study design, exposure, and outcome classification. In 21 studies (19%), the outcome was any childhood cancer. Of the 91 papers that reported on specific types of cancer, 62% did not report the cancer classification system. The most frequently investigated medication groups were sex hormones (46 studies, excluding fertility medications), and antiinfectives (37 studies). Suggestions for strengthening future pharmacoepidemiologic studies on maternal medication use and childhood cancer relate to choice of cancer classification system, exposure windows, and methods for identification of, and control for, potential confounders.

Cancer Risk in Children and Young Adults (Offspring) Born after Medically Assisted Reproduction: A Systematic Review and Meta-Analysis

Many studies have investigated the relationship between medically assisted reproduction (MAR) and health outcomes, particularly cancer, in the offspring. This meta-analysis investigated the association between MAR and childhood cancer. Data sources were PubMed, Scopus, and Web of Science up until June 2018. From the selected studies, we extracted the cancer risk estimates of the exposure of interest (MAR, assisted reproductive technology—ART, and in fitro fertilization—IVF). We conducted the meta-analysis using a random effects model. The outcomes of interest were childhood cancers, classified according to the international classification of childhood cancer (ICCC-3). In our meta-analysis (18 cohort and 15 case-control studies) the overall cancer risk was significantly increased in children conceived by MAR, ART, or IVF. MAR and ART significantly increased the risk for hematological tumors, hepatic tumors, and sarcomas (odds ratio (OR) 1.54; 95% CI 1.18–2.02 and OR 1.92; 95% CI 1.34–2.74, respectively). MAR increased acute myeloid leukemia risk (OR 1.41; 95% CI 1.02–1.95) and ART increased neural cancer risk (OR 1.21; 95% CI 1.01–1.46). Our results suggest an increased risk of cancer in children conceived by MAR. Further studies are needed to investigate the impact of fertility treatments, parental subfertility status, and their association on health outcomes in the offspring.

Cancer risk in children and young adults born preterm: A systematic review and meta-analysis

Introduction

Risk of developing a malignancy when born premature is unknown. We hypothesised that risk of certain cancers might be increased in youth born preterm versus term. We therefore performed a systematic review and meta-analysis to evaluate the incidence of malignancy in the context of preterm birth, according to various cancer types.

Methods

The study was designed per MOOSE and PRISMA guidelines. Articles were identified through November 2015. Observational studies exploring the association between childhood malignancy and birth characteristics were included. Of the 1658 records identified, 109 full text articles were evaluated for eligibility. Random effects meta-analyses were conducted on 10/26 studies retained; 95% confidence intervals were computed and adjusted following sensitivity analysis. Publication bias was evaluated using funnel plots, Begg’s and Egger’s tests.

Results

No differences in risk of primary central nervous system tumor [OR 1.05; 95% CI 0.93–1.17, 5 studies, 580 cases] and neuroblastoma [OR 1.09; 95% CI 0.90–1.32, 5 studies, 211 cases] were observed in individuals born <37 versus ≥37 weeks’ gestation. Preterm birth was consistently associated with hepatoblastoma [ORs 3.12 (95% CI 2.32–4.20), 1.52 (95% CI 1.1–2.1), 1.82 (95% CI 1.01–3.26), and 2.65 (95% CI 1.98–3.55)], but not leukemia, astrocytoma, ependymoma, medulloblastoma, lymphoma, nephroblastoma, rhabdomyosarcoma, retinoblastoma or thyroid cancer.

Conclusions

Children born premature may be at increased risk for hepatoblastoma but there is no strong evidence of an increased risk of primary central nervous system tumours or neuroblastoma. There is insufficient evidence to conclude whether prematurity modulates the risk of other childhood cancers.

Pediatric cancer risk in association with birth defects: A systematic review

BACKGROUND

Many epidemiological studies have examined associations between birth defects (BDs) and pediatric malignancy over the past several decades. Our objective was to conduct a systematic literature review of studies reporting on this association.

METHODS

We used librarian-designed searches of the PubMed Medline and Embase databases to identify primary research articles on pediatric neoplasms and BDs. English language articles from PubMed and Embase up to 10/12/2015, and in PubMed up to 5/12/2017 following an updated search, were eligible for inclusion if they reported primary epidemiological research results on associations between BDs and pediatric malignancies. Two reviewers coded each article based on the title and abstract to identify eligible articles that were abstracted using a structured form. Additional articles were identified through reference lists and other sources. Results were synthesized for pediatric cancers overall and for nine major pediatric cancer subtypes.

RESULTS

A total of 14,778 article citations were identified, of which 80 met inclusion criteria. Pediatric cancer risk was increased in most studies in association with BDs overall with some notable specific findings, including increased risks for CNS tumors in association with CNS abnormalities and positive associations between rib anomalies and several pediatric cancer types.

CONCLUSIONS

Some children born with BDs may be at increased risk for specific pediatric malignancy types. This work provides a foundation for future investigations that are needed to clarify specific BD types predisposing toward malignancy and possible underlying causes of both BDs and malignancy.

Temporal clustering of neuroblastic tumours in children and young adults from Northern England

BACKGROUND

The aetiology of neuroblastic tumours is unclear with both genetic and environmental factors implicated. The possibility that an infectious agent may be involved has been suggested. 'Temporal clustering' occurs if cases display an irregular temporal distribution and may indicate the involvement of an agent that exhibits epidemicity. We tested for the presence and nature of temporal clustering using population-based data from northern England.

METHODS

We extracted all cases of neuroblastic tumours diagnosed in children and young adults aged 0-24 years during 1968-2011 from the Northern Region Young Persons' Malignant Disease Registry. This is a population-based registry, covering a population of approximately 900,000 young persons, and includes all cases resident in northern England at the time of diagnosis. Tests for temporal clustering were applied using a modified version of the Potthoff-Whittinghill method. Estimates of extra-Poisson variation (β) and standard errors (SEs) were obtained.

RESULTS

227 cases of neuroblastic tumours were diagnosed during the study period. All the analyses between fortnights and between months found significant extra-Poisson variation, with β = 0.846 (SE = 0.310, P = 0.004) for the analysis between fortnights within months. Restricting the analyses to the 76 cases diagnosed at ages less than 18 months showed significant extra-Poisson variation between fortnights within months (β = 1.532, SE = 0.866, P = 0.038), but not between months. In contrast, analyses of cases aged 18 months to 24 years showed significant extra-Poisson variation between quarters within years, as well as over shorter timescales.

CONCLUSIONS

Transient environmental agents may be involved in the aetiology of neuroblastic tumours. The initiating factor might be a geographically-widespread agent that occurs in 'mini-epidemics'.

Assisted reproductive technology and somatic morbidity in childhood: a systematic review

OBJECTIVE

To assess whether children conceived by assisted reproductive technology are at increased risk of somatic morbidity in childhood compared with spontaneously conceived children.

DESIGN

Systematic review.

SETTING

None.

PATIENT(S)

Children conceived by assisted reproductive technology and reference groups of spontaneously conceived children or children from the background population.

INTERVENTION(S)

Medline/Pubmed, Embase, and the Cochrane Library were searched as well as reference lists of the retrieved relevant studies. Only cohort studies and case-control studies were included. All studies were scored using the Newcastle-Ottawa scale to assess study quality and the risk of bias in the individual studies.

MAIN OUTCOME MEASURE(S)

Postneonatal somatic diseases, health care use, chronic illnesses (unspecified), surgery, use of medication, and mortality.

RESULT(S)

Thirty-eight studies were included. Results indicated that children conceived by assisted reproductive technology may be at increased risk of unspecified infectious and parasitic diseases, asthma, genitourinary diseases, epilepsy or convulsions, and longer hospitalizations. However, several results in individual studies were not statistically significant and some inconsistency existed between study results. No differences between groups were found regarding hospital admission, outpatient visits, or use of medication. Results regarding mortality, unspecified cancer, pneumonia, allergy, respiratory, and gastrointestinal diseases were contradictory. When considering only the 13 studies allocated the highest score on the Newcastle-Ottawa scale, similar results were found.

CONCLUSION(S)

Children conceived by assisted reproductive technology may be at increased risk of somatic morbidity in childhood compared with spontaneously conceived children, although some inconsistency exists between study results.

Neonatal tumours

Neonatal or perinatal tumours frequently relate to prenatal or developmental events and have a short exposure window which provides an opportunity to study tumours in a selective sensitive period of development. As a result, they display a number of host-specific features which include occasional spontaneous maturational changes with cells still responding to developmental influences. Neonatal tumours (NNT) are studied for a number of important reasons. Firstly, many of the benign tumours arising from soft tissue appear to result from disturbances in growth and development and some are associated with other congenital anomalies. Study of these aspects may open the door for investigation of genetic and epigenetic changes in genes controlling foetal development as well as environmental and drug effects during pregnancy. Secondly, the clinical behaviour of NNT differs from that of similar tumours occurring later in childhood. In addition, certain apparently malignant NNT can 'change course' in infancy leading to the maturation of apparently highly malignant tumours. Thirdly, NNT underline the genetic associations of most tumours but appear to differ in the effects of proto-oncogenes and other oncogenic factors. In this context, there are also connections between the foetal and neonatal period and some "adult" cancers. Fourthly, they appear to arise in a period in which minimal environmental interference has occurred, thus providing a unique potential window of opportunity to study the pathogenesis of tumour behaviour. This study will seek to review what is currently known in each of these areas of study as they apply to NNT. Further study of the provocative differences in tumour behaviour in neonates provides insights into the natural history of cancer in humans and promotes novel cancer therapies.

Association of maternal education with the neuroblastoma susceptibility in children: a meta-analysis

Maternal education might be an important factor for the neuroblastoma risk in children, but it was conflicting. This meta-analysis was performed to evaluate the relationship between maternal education and neuroblastoma susceptibility and to explore whether maternal education was an important indicator to be associated with the neuroblastoma risk in children. The association studies were identified from the databases of PubMed, and Cochrane Library as of June 1, 2012, and eligible investigations were synthesized using meta-analysis method. Results were expressed with odds ratios (OR) for dichotomous data, and 95% confidence intervals (CI) were also calculated. Six literatures were identified for the analysis of association between maternal education and neuroblastoma susceptibility in children, consisting of 2063 patients with cancer and 13,925 controls. There was no a marked association between maternal education and neuroblastoma susceptibility when the maternal education was less than high school (OR = 0.66, 95% CI: 0.43-1.01, P = .06). We also found that maternal education was not associated with the neuroblastoma susceptibility when the maternal education was high school (OR = 0.74, 95% CI: 0.31-1.75, P = .49) and more than high school (OR = 0.78, 95% CI: 0.33-1.85, P = .58). In conclusion, maternal education is not associated with the neuroblastoma susceptibility in children. However, more investigations are required to further clarify the association of maternal education with the neuroblastoma susceptibility in children.

Cancer in children with nonchromosomal birth defects

OBJECTIVE

To examine whether the incidence of childhood cancer is elevated in children with birth defects but no chromosomal anomalies.

STUDY DESIGN

We examined cancer risk in a population-based cohort of children with and without major birth defects born between 1988 and 2004, by linking data from the California Birth Defects Monitoring Program, the California Cancer Registry, and birth certificates. Cox proportional hazards models generated hazard ratios (HRs) and 95% CIs based on person-years at risk. We compared the risk of childhood cancer in infants born with and without specific types of birth defects, excluding infants with chromosomal anomalies.

RESULTS

Of the 4869 children in the birth cohort with cancer, 222 had a major birth defect. Although the expected elevation in cancer risk was observed in children with chromosomal birth defects (HR, 12.44; 95% CI, 10.10-15.32), especially for the leukemias (HR, 28.99; 95% CI, 23.07-36.42), children with nonchromosomal birth defects also had an increased risk of cancer (HR, 1.58; 95% CI, 1.33-1.87), but instead for brain tumors, lymphomas, neuroblastoma, and germ cell tumors.

CONCLUSION

Children with nonchromosomal birth defects are at increased risk for solid tumors, but not leukemias. Dysregulation of early human development likely plays an important role in the etiology of childhood cancer.

Birth order and risk of childhood cancer: a pooled analysis from five US States

The causes of childhood cancers are largely unknown. Birth order has been used as a proxy for prenatal and postnatal exposures, such as frequency of infections and in utero hormone exposures. We investigated the association between birth order and childhood cancers in a pooled case-control dataset. The subjects were drawn from population-based registries of cancers and births in California, Minnesota, New York, Texas and Washington. We included 17,672 cases <15 years of age who were diagnosed from 1980 to 2004 and 57,966 randomly selected controls born 1970-2004, excluding children with Down syndrome. We calculated odds ratios and 95% confidence intervals using logistic regression, adjusted for sex, birth year, maternal race, maternal age, multiple birth, gestational age and birth weight. Overall, we found an inverse relationship between childhood cancer risk and birth order. For children in the fourth or higher birth order category compared to first-born children, the adjusted OR was 0.87 (95% CI: 0.81, 0.93) for all cancers combined. When we examined risks by cancer type, a decreasing risk with increasing birth order was seen in the central nervous system tumors, neuroblastoma, bilateral retinoblastoma, Wilms tumor and rhabdomyosarcoma. We observed increased risks with increasing birth order for acute myeloid leukemia but a slight decrease in risk for acute lymphoid leukemia. These risk estimates were based on a very large sample size, which allowed us to examine rare cancer types with greater statistical power than in most previous studies, however the biologic mechanisms remain to be elucidated.

Kabuki syndrome and cancer in two patients

Both hepatoblastoma and neuroblastoma are occasionally associated with congenital syndromes such as Beckwith-Wiedemann syndrome and trisomy 18. There have been no reports of hepatoblastoma in patients with Kabuki syndrome, whereas one patient with neuroblastoma and this syndrome has been reported. In this paper we present two patients with Kabuki syndrome and a neoplasm: a child of 6 years with hepatoblastoma and an infant, of 6 months affected by neuroblastoma.

Birth weight and risk of neuroblastoma: a meta-analysis

BACKGROUND

Neuroblastoma is the most common solid tumour in infancy but its aetiology is largely unknown. Prenatal factors might play a key role in its pathogenesis. Previous studies investigated whether birth weight is associated with risk of neuroblastoma, with conflictive results. We conducted a meta-analysis to quantitatively summarize the published evidence.

METHODS

Results from 10 case-control studies and one cohort study (1966 to December 2008) were included, involving a total of 3004 children with neuroblastoma. We constructed random-effects and fixed-effects models, performed 'pool-first' analyses, assessed heterogeneity and publication bias and performed sensitivity and influence analyses.

RESULTS

High birth weight (>4000 g) was associated with increased risk of neuroblastoma [odds ratio (OR) 1.19; 95% confidence interval (CI) 1.04-1.36]. Results for high birth weight were highly homogenous (I(2) = 0%). Low birth weight (<2500 g) was also related to increased risk of neuroblastoma (OR 1.24; 95% CI 1.0-1.55), but results were more heterogeneous (I(2 )= 30%). No evidence for particularly influential studies or for publication bias was found. However, sensitivity analysis indicated the presence of bias in studies on the association with low birth weight. Above 2500 g each 1000-g increase in birth weight was associated with a 13% (95% CI 3-25) increase in risk of neuroblastoma.

CONCLUSIONS

This meta-analysis shows that high birth weight is highly reproducibly associated with increased risk of neuroblastoma. The association with low birth weight was found to be less robust and deserves further studies.

Molecular pathogenesis of peripheral neuroblastic tumors

Neuroblastoma (NB) is an embryonal cancer of the sympathetic nervous system observed in early childhood, characterized by a broad spectrum of clinical behaviors, ranging from spontaneous regression to fatal outcome despite aggressive therapies. NB accounts for 8-10% of pediatric cancers and 15% of the deaths attributable to malignant conditions in children. Interestingly, NB may occur in various contexts, being mostly sporadic but also familial or syndromic. This review focuses on recent advances in the identification of the genes and mechanisms implicated in NB pathogenesis. Although the extensive characterization of the genomic aberrations recurrently observed in sporadic NBs provides important insights into the understanding of the clinical heterogeneity of this neoplasm, analysis of familial and syndromic cases also unravels essential clues on the genetic bases of NB. Recently, the ALK gene emerged as an important NB gene, being implicated both in sporadic and familial cases. The identification of gene expression signatures associated with patient's outcome points out the potential of using gene expression profiling to improve clinical management of patients suffering from NB. Finally, based on recent observations integrating genomic analyses, biological data and clinical information, we discuss possible evolution/progression schemes in NB.

Prevalence of congenital heart defects in neuroblastoma patients: a cohort study and systematic review of literature

Data on the prevalence of congenital heart defects (CHD) in neuroblastoma patients are inconsistent. If CHD are more common in neuroblastoma patients than in the general population, cardiac screening might be warranted. In this study we used echocardiography to determine the prevalence of CHD in a single centre cohort of surviving neuroblastoma patients. In addition, we performed a systematic review of the literature. Echocardiography was performed in 119 of 133 patients (89.5%). Only two patients (1.7%) had CHD. The prevalence of CHD was not significantly different from a previously published control group of 192 leukaemia patients examined by echocardiography (P = 0.49). Literature search revealed 17 studies, showing prevalence rates of CHD in neuroblastoma patients ranging from 0 to 20%. Prevalence was less than 3.6% in the majority of studies. Most studies lacked information on validity. We conclude that current evidence does not support standard cardiac screening in all patients with neuroblastoma.

Developmental genes and cancer in children

Childhood tumours are associated with congenital abnormalities suggesting that disruption of normal developmental processes may be linked with oncogenesis. Genetic and environmental exposures may combine to disrupt critical epigenetic processes during development, thus affecting gene-related signalling pathways and cellular function. This review examines the role of critical genes and processes regulating development such as the polycomb family and sonic hedgehog (SHH) as well as the Wnt signalling pathways and epigenetic variations (Snf5), methylation and loss of heterozygosity in controlling homeotic gene transcription and intracellular chromatin structure. The developmental and perinatal periods appears important as a window of opportunity for cancer research.

Perinatal risk factors for neuroblastoma

Neuroblastoma is the most common cancer among infants, suggesting an etiologic role for prenatal factors. In this case-cohort study, neuroblastoma cases (n = 529) diagnosed between 1985 and 2001 were identified from the New York State Cancer Registry and were matched to the electronic birth records for 1983-2001 from New York State and New York City. Controls (n = 12,010) were selected from the same birth cohorts. Analysis was stratified by age at diagnosis, with one to six months (younger infants), seven to 18 months (older infants), and older than 18 months (older children) analyzed separately. Perinatal exposure data was obtained from the birth certificates. No risk factors were identified to be consistently associated with risk across all three age groups. Generally, more risk factors were identified as associated with neuroblastoma among younger infants relative to older ages, including high birth weight, heavier maternal gestational weight gain, maternal hypertension, older maternal age, ultrasound, and respiratory distress. Among older infants, low birth weight was associated with increased risk while heavier maternal gestational weight gain was protective. In the oldest age group, first born status, primary cesarean delivery, prolonged labor and premature rupture of the membranes were associated with increased risk.