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Table 2 PFS and OS by risk factors of 268 stage 4 s neuroblastoma patients

From: Stage 4 s neuroblastoma: features, management and outcome of 268 cases from the Italian Neuroblastoma Registry

Entire cohort

 

Progressions

10-yrs PFS

p

Deaths

10-year OS

p

No. (%)

No. (%)

% (95% CI)

No. (%)

% (95% CI)

268 (100)

83 (31)

68.2 (62.1–73.5)

46 (17.2)

82.7 (77.4–86.8)

Treatment era

 1979–1984

26 (9.7)

8 (30.8)

69.2 (47.8–83.3)

0.217#

6 (23.1)

76.9 (55.7–88.9)

0.041#

 1985–1999

116 (43.3)

43 (37.1)

62.3 (52.7–70.5)

 

26 (22.4)

77.2 (68.3–83.9)

 

 2000–2013

126 (47)

32 (25.4)

72.4 (62.4–80.1)

 

14 (11.1)

89.7 (82.9–93.9)

 

Gender

 Male

156 (58.2)

52 (33.3)

65.4 (57.1–72.5)

0.24

34 (21.8)

78.5 (71.1–84.2)

0.018

 Female

112 (41.8)

31 (27.7)

72.1 (62.7–79.5)

 

12 (10.7)

88.5 (80.3–93.4)

 

Age, days

 0–29

60 (22.4)

23 (38.3)

59.8 (45.7–71.4)

0.033#

17 (28.3)

73.0 (59.7–82.5)

0.067#

 30–59

40 (14.9)

14 (35.0)

65.0 (48.2–77.6)

 

8 (20.0)

80.0 (64.0–89.5)

 

 60–89

37 (13.8)

9 (24.3)

75.0 (57.5–86.1)

 

6 (16.2)

83.8 (67.4–92.4)

 

 90–119

40 (14.9)

15 (18.1)

61.6 (44.6–74.8)

 

7 (17.5)

81.0 (63.5–90.6)

 

  ≥ 120

91 (33.9)

22 (26.5)

75.5 (65.2–83.1)

 

8 (8.8)

91.0 (82.7–95.4)

 

Age, days

 0–29

60 (22.4)

23 (38.3)

59.8 (45.7–71.4)

0.058

17 (28.3)

73.0 (59.7–82.5)

0.006

 30–365

208 (77.6)

60 (28.8)

70.7 (64.0–76.4)

 

29 (19.9)

85.5 (79.6–89.7)

 

Symptoms at presentation

 None

17 (6.3)

1 (5.9)

94.1 (65.0–99.2)

< 0.001#

0

100

< 0.001#

 Yes, minor

51 (19.0)

9 (17.7)

82.4 (68.8–90.4)

 

2 (3.9)

96.0 (84.9–99.0)

 

 Yes, major

200 (74.6)

73 (36.5)

62.4 (55.1–68.8)

 

44 (22.0)

77.9 (71.3–83.2)

 

Hepatomegaly

 None

82 (30.6)

15 (18.3)

81.7 (71.5–88.5)

0.004

4 (4.9)

94.7 (86.5–98.0)

< 0.001

 Yes

186 (69.4)

68 (36.6)

62.2 (54.6–68.9)

 

42 (22.6)

77.4 (70.6–82.9)

 

Dyspnea

 None

216 (80.6)

57 (26.4)

73.4 (66.9–78.8)

< 0.001

24 (11.1)

88.4 (83.1–92.2)

< 0.001

 Yes

52 (19.4)

26 (50)

47.1 (32.5–60.3)

 

22 (42.3)

59.5 (44.9–71.4)

 

Organ dysfunctions

 None

234 (87.3)

72 (30.8)

68.8 (62.4–74.4)

0.714

36 (15.4)

84.0 (78.4–88.2)

0.032

 Yes

34 (12.7)

11 (32.4)

64.5 (44.3–78.9)

 

10 (29.4)

73.5 (55.3–85.3)

 

Combinations of major symptoms

 No major symptoms

68 (25.4)

10 (14.7)

85.3 (74.4–91.8)

< 0.001

2 (2.9)

97.0 (88.6–99.2)

< 0.001

 Hepatomegaly ± Organ dysfunction

146 (54.5)

47 (32.2)

67.4 (59.0–74.4)

 

22 (15.1)

84.4 (77.2–89.5)

 

 Dyspnea ± Organ dysfunction

12 (4.5)

5 (41.7)

58.3 (27.0–80.1)

 

2 (16.7)

83.3 (48.2–95.6)

 

 Hepatomegaly + Dyspnea (±Organ dysfunction)

40 (14.9)

21 (52.5)

43.0 (26.3–58.7)

 

20 (50)

52.4 (36.0–66.4)

 

 Organ dysfunction only

2 (0.8)

0

100

 

0

100

 

Abdominal mass

 None

234 (87.3)

77 (32.9)

66.1 (59.5–71.9)

0.078

45 (19.2)

80.6 (74.7–85.2)

0.023

 Yes

34 (12.7)

6 (17.6)

82.4 (64.9–91.7)

 

1 (2.9)

97.1 (80.9–99.6)

 

Cervical mass

 None

257 (95.9)

80 (31.1)

68.0 (61.8–73.4)

0.797

44 (17.1)

82.8 (77.5–87.0)

0.896

 Yes

11 (4.1)

3 (27.3)

72.7 (37.1–90.3)

 

2 (18.2)

77.9 (35.4–94.2)

 

Skin nodules

 No

226 (84.3)

64 (28.3)

70.7 (64.1–76.3)

0.029

36 (15.9)

83.9 (78.2–88.3)

0.255

 Yes

42 (15.7)

19 (45.2)

54.8 (38.7–68.3)

 

10 (23.8)

75.9 (59.7–86.2)

 

Neurologic symptoms

 None

256 (95.5)

77 (30.1)

69.1 (62.9–74.5)

0.148

45 (17.6)

82.6 (77.3–86.8)

0.404

 Yes

12 (4.5)

6 (50)

50.0 (20.9–73.6)

 

1 (8.3)

75.0 (12.8–96.1)

 

Primary site

 Adrenal

175 (65.3)

59 (33.7)

65.8 (58.2–72.3)

0.609

33 (18.8)

80.4 (73.5–85.8)

0.489

 Abdomen

49 (18.3)

11 (22.5)

75.0 (58.7–85.6)

 

7 (14.3)

87.8 (74.8–94.3)

 

 Thorax

22 (8.2)

7 (31.8)

68.2 (44.6–83.4)

 

1 (4.5)

95.5 (71.9–99.4)

 

 Neck

9 (3.4)

3 (33.3)

66.7 (28.2–87.8)

 

2 (22.2)

71.1 (23.3–92.3)

 

 Not detected

13 (4.9)

3 (23.1)

76.9 (44.2–91.9)

 

3 (23.1)

76.9 (44.2–91.9)

 

Primary site thorax

 No

246 (91.8)

76 (30.9)

68.9 (62.7–74.4)

0.944

45 (18.3)

81.5 (75.8–85.9)

0.112

 Yes

22 (8.2)

7 (31.8)

68.2 (44.6–83.4)

 

1 (4.5)

95.5 (71.9–99.4)

 

Liver infiltration

 No

38 (14.2)

7 (18.4)

81.6 (65.2–90.8)

0.084

0

100

0.004

 Yes

230 (85.8)

76 (33)

65.9 (59.3–71.8)

 

46 (20)

79.8 (73.7–84.5)

 

Positive bone marrow cytology

 No

157 (58.6)

49 (31.2)

68.3 (60.3–75.0)

0.753

28 (17.8)

81.9 (74.9–87.2)

0.643

 Yes

111 (41.4)

34 (30.6)

68.1 (58.2–76.2)

 

18 (16.2)

83.6 (74.6–89.6)

 

Urine VMA (222 tested)

 Normal

59 (26.6)

16 (27.1)

72.4 (59.0–82.1)

0.381

5 (8.5)

91.5 (80.8–96.4)

0.13

 Elevated

163 (73.4)

53 (32.5)

66.7 (58.7–73.5)

 

27 (16.6)

83.9 (77.2–88.7)

 

Urine HVA (112 tested)

 Normal

18 (16.1)

4 (22.2)

77.8 (51.1–91.0)

0.253

2 (11.1)

88.9 (62.4–97.1)

0.846

 Elevated

94 (83.9)

33 (35.1)

64.0 (53.0–73.0)

 

12 (12.8)

88.3 (79.9–93.3)

 

Serum LDH (227 tested)

 Normal

131 (57.7)

33 (25.2)

74.6 (66.2–81.2)

0.055

14 (10.7)

89.1 (82.3–93.4)

0.031

 Elevated

96 (42.3)

35 (36.5)

60.9 (49.6–70.4)

 

20 (20.8)

78.8 (68.1–86.2)

 

Serum Ferritin (193 tested)

 Normal

116 (60.1)

34 (29.3)

70.5 (61.2–77.9)

0.859

15 (12.9)

87.0 (79.4–92.0)

0.425

 Elevated

77 (39.9)

22 (28.6)

70.0 (58.1–79.1)

 

13 (16.9)

82.8 (72.1–89.6)

 

MYCN gene (183 tested)

 Normal

168 (91.8)

53 (31.5)

67.1 (59.1–73.9)

0.673

21 (12.5)

86.8 (79.9–91.5)

0.021

 Amplified

15 (8.2)

6 (40)

60.0 (31.8–79.7)

 

5 (33.3)

66.7 (37.5–84.6)

 

1p chromosome (138 tested)

 Normal

110 (79.7)

31 (28.2)

71.3 (61.7–78.8)

0.141

10 (9.1)

89.1 (79.2–94.4)

< 0.001

 Deleted

28 (20.3)

13 (46.4)

50.8 (29.7–68.5)

 

10 (35.7)

67.9 (47.3–81.8)

 

DNA index (121 tested)

 Aneuploid

80 (66.1)

24 (30)

70.0 (58.7–78.8)

0.734

3 (3.8)

96.3 (88.8–98.8)

< 0.001

 Di-tetraploid

41 (33.9)

14 (34.2)

65.8 (49.1–78.1)

 

10 (24.4)

70.8 (49.2–84.5)

 

Histology INPC (75 tested)

 Favourable

69 (92)

16 (23.2)

73.9 (59.3–83.9)

0.78

5 (7.3)

94.2 (85.3–97.8)

0.147

 Unfavourable

6 (8)

2 (33.3)

66.7 (19.5–90.4)

 

2 (33.3)

66.7 (19.5–90.4)

 

Upfront treatment

 Observation

69 (25.8)

31 (44.9)

55.1 (42.6–65.9)

0.015

13 (18.8)

81.1 (69.7–88.6)

< 0.001

 Chemotherapy

90 (33.6)

29 (32.2)

66.8 (55.8–75.6)

 

23 (25.6)

73.2 (62.2–81.5)

 

 Resection of primary

76 (28.4)

14 (18.4)

81.1 (70.2–88.3)

 

4 (5.3)

94.3 (85.4–97.9)

 

 Chemotherapy + Resection of primary

19 (7.1)

4 (21.1)

76.6 (48.0–90.7)

 

2 (10.5)

94.7 (68.1–99.2)

 

 Radiotherapy + Other

14 (5.2)

5 (35.7)

64.3 (34.3–83.3)

 

4 (28.6)

71.4 (40.6–88.2)

 
  1. Abbreviations. PFS progression-free survival, OS overall survival, VMA vanillylmandelic acid, HVA homovanillic acid, LDH lactate dehydrogenase, INPC international neuroblastoma pathology classification
  2. #; test for trend