title: Neuroblastoma: outcome over a 14 year period from a tertiary care referral centre in India.
abstract: OBJECTIVE
  To evaluate the outcome of children with neuroblastoma (NB) from a tertiary care referral centre in India.
  
  
  METHODS
  All children with NB registered from October 1996 through July 2009 were included in the study. INSS was used for staging. All children included in the study received chemotherapy and radiation therapy appropriate for stage. Tumor resection was done when feasible. The final outcome was overall survival and it was categorized as Complete Response (CR), Partial Response (PR); No Response (NR) and Progressive Disease (PD). Analysis of three-year overall survival was done using Kaplan Meier method and Log Rank test of significance. Multivariate analysis for significance of age, site and stage was performed.
  
  
  RESULTS
  144 children in the age range of 1-132months (median 36) were enrolled. Only 38 (26.4%) children were below 12months. 112 (77.8%) of the tumors were abdominal and 32 (22.2%) were extra-abdominal. Stage distribution was 1+2 in 6 (4.2%); 3 in 58 (40.3%); 4 in 68 (47.2%); 4s in 12 (8.3%). 83 (57.6%) underwent gross complete resection. At the time of last follow-up, 100 (69.4%) were alive [60 CR (41.7%); 33 PR; 7 PD/NR] and 44 (30.6%) were dead [1CR; 11PR; 32 PD/NR]. The three-year OS was 60.7% [95 CI 50.4-69.5]. The OS was 69.7% for those<12months of age [95 CI 51.8-82.0] and CR was achieved in 57.9%, while for those >12months the OS was 55.3% [95 CI 42.2-66.6] and CR was achieved in 35.8% (p=0.73). All 6 (100%) patients with Stage 1 and Stage 2 disease were alive and disease free. The OS was 71.5% for Stage 3[95 CI 55.3-82.7] and CR was achieved in 56.9%, while for Stage 4 the OS was 35.7%[95 CI 19.3-52.4] and CR was achieved in 17.6% (p=0.001). The OS was 83.3% for 4s [95 CI 48.2-95.6] and CR was achieved in 75%.
  
  
  CONCLUSIONS
  All the six children with Stage 1 & 2 achieved CR and were alive, while 57% of Stage 3 could achieve CR and had an OS of 71.5%. The OS (35.7%) and CR (17.6%) for Stage 4 were significantly less (p=0.001).
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. Electronic address: sandpagr@hotmail.com.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Agarwala
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Mandelia
authors.affiliation: Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: M
authors.initials: M
authors.lastname: Srinivas
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Minu
authors.initials: M
authors.lastname: Bajpai
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India.
authors.forename: Veereshwar
authors.initials: V
authors.lastname: Bhatnagar
mesh_terms: D001706:Biopsy; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers
keywords: Neuroblastoma; Outcome; Survival; Treatment