title: Survival of high-risk pediatric neuroblastoma patients in a developing country.
abstract: Little information is available about survival of high-risk pediatric neuroblastoma patients in developing countries. We aimed to assess survival among high-risk pediatric neuroblastoma patients in La Plata, Argentina. Individuals eligible for our cohort were aged <20 yr when diagnosed with high-risk neuroblastoma and received cancer-directed therapy including stem cell transplantation at Hospital de Niños Sor Maria Ludovica between February 1999 and February 2015. We estimated overall survival probabilities using an extended Kaplan-Meier approach. Our study population comprised 39 high-risk neuroblastoma patients, of whom 39% were aged >4 yr at diagnosis, 54% were male, and 62% had adrenal neuroblastoma. We observed 18 deaths, and the median survival time of our study population was 1.7 yr. The five-yr overall survival probability was 24% (95% CL: 10%, 41%). In contrast, five-yr survival of high-risk neuroblastoma patients ranges between 23% and 76% in developed countries. Survival among high-risk neuroblastoma patients is generally poor regardless of geographic location, but our results illustrate dramatically worse survival for patients in a developing country. We speculate that the observed survival differences could be attenuated or eliminated with improvements in treatment and supportive care, but addressing these issues will require creative solutions because of resource limitations.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.|School of Medicine, Indiana University, Indianapolis, IN, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Easton
authors.affiliation: Department of Hematology, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina.
authors.forename: Sergio
authors.initials: S
authors.lastname: Gomez
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Asdahl
authors.affiliation: Department of Public Health, University of Southern Mississippi, Gulfport, MS, USA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Conner
authors.affiliation: Department of Hematology, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina.
authors.forename: Alcira B
authors.initials: AB
authors.lastname: Fynn
authors.affiliation: Department of Hematology, Hospital de Niños Sor Maria Ludovica, La Plata, Argentina.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ruiz
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Rohit P
authors.identifier: http://orcid.org/0000-0003-0595-8990
authors.initials: RP
authors.lastname: Ojha
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000401:mortality* / Q000628:therapy; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality* / Q000628:therapy; D009447:Neuroblastoma / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000401:mortality* / Q000628:therapy; D012306:Risk; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D055815:Young Adult
keywords: developing country; disparity; mortality; neuroblastoma; stem cell transplantation