Outcome of treatment for childhood cancer in black as compared with white children. The St Jude Children's Research Hospital experience, 1962 through 1992

C. H. Pui, J. M. Boyett, M. L. Hancock, C. B. Pratt, W. H. Meyer and W. M. Crist
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.

OBJECTIVE. To determine whether there is a racial difference in prognosis among childhood cancers. DESIGN. An overall (30-year) survival analysis by race was followed by separate studies for "early" and "recent" treatment eras, defined by time points at which significantly improved outcome was demonstrated for specific tumor types. Stratified analyses were performed to adjust for recognized prognostic features. SETTING. Pediatric oncology research and treatment center. PATIENTS. The study included 798 black and 4507 white children with newly diagnosed malignancies treated from January 1962 through June 1992. These patients were accepted for treatment regardless of their financial status and were enrolled on disease-specific protocols. RESULTS. Across the 30-year study period, black children had a significantly poorer rate of survival than white children (P < .001, log-rank test). In the early treatment era, a significant difference was seen for all forms of cancer combined (P < .001), with 10-year Kaplan-Meier estimates (+/- SE) of 37% +/- 3% for black children and 50% +/- 1% for white children. This difference largely reflected the poorer prognosis of black children with the most common childhood cancer, acute lymphoblastic leukemia. In the recent treatment era, there were no significant differences in treatment outcome by race for specific disease categories or for all forms of cancer combined. Ten-year survival rates were 67% +/- 6% for black children and 66% +/- 3% for white children, indicating a significantly greater improvement in the former group. CONCLUSION. With equal access to effective contemporary treatment, black children with cancer fare as well as white children when treated with protocol-based therapy at a pediatric oncology research center.

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