Diagnostic delay as a prognostic factor for non-response to treatment and relapse in Mexican pediatric patients with central nervous system tumors.
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BACKGROUND: Central nervous system tumors (CNST) are among the most common solid tumors in children and represent a major cause of cancer-related morbidity and mortality. Early diagnosis is essential to improve treatment outcomes; however, nonspecific symptoms often lead to diagnostic delays. Prolonged time to diagnosis may allow disease progression and negatively affect treatment response. Understanding the impact of diagnostic delays can help identify barriers to timely care and improve clinical outcomes in pediatric patients. OBJECTIVE: This study aimed to explore the link between diagnostic delays and relapse on treatment non-response in pediatric patients with central nervous system tumors (CNST). METHODS: A cohort of 111 patients with newly diagnosed CNST tumors was evaluated. Treatment response was assessed using Response Assessment in Neuro-Oncology (RANO) criteria. A diagnostic delay was considered when the diagnosis was made more than 1, 3, or 6 months after the initial clinical presentation. Kaplan-Meier curves were plotted to assess the probability of treatment response by diagnostic delay of more than 1, 3, and 6 months. RESULTS: The median time from symptom onset to diagnosis was 80 days (Q2529-Q75195). Kaplan-Meier analysis showed that diagnostic delays >1 and >3 months were associated with a higher probability of non-response to treatment (p = 0.014 and p = 0.004, respectively). In multivariable Cox analysis adjusted for age and sex, delays >1 month (HR 2.003, 95% CI 1.23-3.24; p = 0.005) and >3 months (HR 1.86, 95% CI 1.20-2.88; p = 0.005) were associated with non-response. Diagnostic delays >1 month (HR 2.690, 95% CI 1.19-6.34; p = 0.043) and >3 months (HR 2.083, 95% CI 1.08-3.96; p = 0.048) were also associated with relapse. CONCLUSION: A delay in diagnosis of more than 1 and 3 months was significantly associated with lack of response to treatment and relapse in patients diagnosed with CNST.