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KMID : 0387820100170010036
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Clinical Pediatric Hematology-Oncology
2010 Volume.17 No. 1 p.36 ~ p.42
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Clinical Characteristic of High-risk Neuroblastoma Patients with Respect to Age at Diagnosis
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Han Hye-Sun
Sung Se-In
Chueh Hee-Won
Lee Soo-Hyun
Yoo Keon-Hee
Sung Ki-Woong
Koo Hong-Hoe
Kim Ju-Youn
Cho Eun-Joo
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Abstract
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Purpose: The purpose of this study was to evaluate the clinical characteristics and outcome of patients with high-risk neuroblastoma with respect to age at diagnosis.
Methods: From January 1997 to December 2008, 76 patients were newly diagnosed with stage 4 neuroblastoma over 1 year of age at diagnosis. Patients were divided into two groups according to age at diagnosis; less than 18 months vs. over 18 months, less than 24 months vs. over 24 months and less than 36 months over 36 months. The clinical characteristics and outcome of patients were investigated with respect to the age.
Results: Difference in the 5-year relapse-free survival rate was biggest when the patients were divided into less than 24 month group (n=17) and over 24 month group (n=59) (91.7+/-15.6% vs. 61.3+/-14.5%, P=0.049). While there was no difference in the toxic death rate between the two groups (11.8% vs. 11.9%), relapse was more frequent in over 24 month group (5.9% vs. 23.7%, P<0.001). There were no differences in sex, stage, histology, lactate dehydrogenase, ferritin, and neuron-specific enolase between the two groups. However, N-myc amplified tumor (> or =3 copies) was more frequent in less than 24 month group (75.0% vs. 39.7%, P=0.012). In the multivariate analysis, age less than 24 months was a favorable factor for relapse-free survival with borderline significance (HR 0.16, 95% CI 0.02~1.35 P=0.078).
Conclusion: Relapse-free survival rate was higher in less than 24 month group than in over 24 month group despite a higher frequency of N-myc amplified tumor in less than 24 month group. Therefore, revision of treatment protocol might be needed to reduce treatment-related toxicity without jeopardizing survival rate in high-risk neuroblastoma patients less than 24 months of age at diagnosis.
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KEYWORD
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Stage 4 Neuroblastoma, Age, Prognosis
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