Prognostic factors of neuroblastoma in limited-resource settings.

Objective: This study aimed to analyze survival and risk factors for death in children with neuroblastoma that may contribute to a viable risk classification for low-income countries.

Methods: A historic cohort involving patients under 19 years of age with neuroblastoma was followed at a reference center in Northeast Brazil between July 2005 and July 2020. Data on sociodemographic, were collected. The outcomes studied were recurrence, disease progression, and five-year mortality. Multivariate analysis of Cox proportional hazards for death was performed. Overall and eventfree survivals were evaluated using the Kaplan-Meier method and the comparison between the groups studied, by the log-rank test.

Results: Patients (n=126) were predominantly female with a median age of 26.5 months. Most presented primary adrenal, tumor stage 4 according to the International Neuroblastoma Staging System, unfavorable histology, and median serum lactate dehydrogenase (LDH) levels of 640.5 U/L. LDH≥640.5 U/L (hazard ratio [HRa] 2.49; 95% confidence interval [CI] 1.57-3.95; p<0.001) and stage 4 (HRa 1.67; 95%CI 1.00-2.78; p=0.047) were identified as risk factors for death. The overall survival was 32.4%, showing distinct curves regarding LDH serum levels and staging (log-rank p<0.05); the event-free survival was 26.3%.

Conclusions: Elevated LDH serum levels were a risk factor for five-year mortality, and can be utilized as a prognostic marker in resource-limited settings.