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A retrospective evaluation of the presentation, prognostic factors and outcomes of neuroblastoma in Ugandan children.

Irene NanyangaGideon Kurigamba KwikirizaBarnabas AtwiineRuth NamazziVictor MusiimeJoyce Balagadde KambuguJaques Johan van Heerden
Published in: Pediatric hematology and oncology (2022)
Neuroblastoma (NB) is the most common extracranial solid tumor of childhood. The complete burden and outcomes in Uganda are unknown. The study was a multicenter retrospective chart review of children aged between 0 to 15 years diagnosed with NB from 2010 to 2020. Demographic, clinical and tumor-related characteristics were extracted for analysis. Kaplan-Meier survival curves and Cox regression models were used to determine the one-year overall survival (OS) and identify prognostic factors. Seventy-five patients were evaluated, with a median age at diagnosis of 48 months (IQR 26-108 months). Fever (74.7%), weight loss (74.7%), high blood pressure (70.3%) and abdominal swelling/mass (65.3%) were the most common features at diagnosis. Suprarenal tumors (52%) and stage 4 disease (70.7%) were also common. The one-year OS was 60.0% (95%CI 56.8%; 64.3%) with a median survival time of 12.6 months (95% CI: 8.1; 20.8). The one-year OS for non-metastatic and metastatic disease was 67.3% and 42.6% ( p  = 0.11) respectively. Leukocytosis ( p  < 0.001) at diagnosis was of prognostic significance while clinical remission after induction chemotherapy ( p  < 0.001) provided survival advantages. Children who received maintenance chemotherapy had a longer median survival time of 38.5 months (range 10.8-69.5). Age ( p  = 0.001), lung metastasis ( p  < 0.001), and leukocytosis ( p  < 0.001) remained significant on multivariate analysis. In this Ugandan study, leukocytosis was a clinical predictor of prognosis, metastatic disease had management challenges and maintenance chemotherapy prolonged the survival time but not OS.
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