Neuroblastoma: Can lessons from the past help to improve the future?

L Coopoosamy, J Schoeman, DT Reynders, FE Omar, A Büchner
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Abstract

Background. The outcome of patients with neuroblastoma in South Africa has always been very poor. We conducted a retrospective study in one state-funded paediatric oncology unit (POU), to describe the clinical course, evaluate prognostic factors and report outcomes of patients with neuroblastoma.Methods. We analysed routine data from one POU, gathered between 1993 and 2018. Kaplan-Meier curves were used to illustrate 2-year survival rates and to evaluate possible prognostic factors.Results. Data from 87 patients were included and analysed. The median age was 41 months. The majority of the patients presented with stage 4 disease (77%). The most common presenting symptoms were bone pain, loss of weight, and abdominal distention. Chemotherapy was administered to 74 patients, and only 5 patients (6%) received palliative chemotherapy as first-line treatment. Only 18 of the 87 patients had surgery (21%) and 13 of 87 had radiation (15%), while 10 patients received palliative radioactive iodine (131I-miBG) therapy. Patients with ferritin levels >120 ng/dL did not have a poorer outcome, and those with a raised lactate dehydrogenase (LDH) level displayed a shorter survival time but it was not statistically significant. The 2-year overall survival was 24% for the whole cohort and 16% for the stage 4 patients at diagnosis.Conclusion. Neuroblastoma is a disease with a dismal outcome in our POU, mostly as a result of late presentation. To improve prognosis the focus should be on recognising danger signs to ensure early diagnosis and referral. We recommend adding danger signs for childhood cancer to the Integrated Management of Childhood Illness (IMCI) strategy in an attempt to improve early recognition and diagnosis of childhood cancer.
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神经母细胞瘤:过去的经验教训是否有助于改善未来?
背景。南非神经母细胞瘤患者的预后一直很差。我们在一家国家资助的儿科肿瘤科(POU)进行了一项回顾性研究,以描述神经母细胞瘤患者的临床过程,评估预后因素并报告结果。我们分析了1993年至2018年间收集的一个POU的常规数据。Kaplan-Meier曲线用于说明2年生存率并评估可能的预后因素。纳入并分析了87例患者的数据。中位年龄为41个月。大多数患者表现为4期疾病(77%)。最常见的症状是骨痛、体重减轻和腹胀。74例患者接受化疗,仅有5例(6%)患者接受姑息性化疗作为一线治疗。87例患者中只有18例进行了手术(21%),13例进行了放射治疗(15%),而10例患者接受了姑息性放射性碘(131I-miBG)治疗。铁蛋白水平为120 ng/dL的患者的预后并不差,乳酸脱氢酶(LDH)水平升高的患者的生存时间较短,但没有统计学意义。整个队列的2年总生存率为24%,诊断时4期患者的2年总生存率为16%。神经母细胞瘤是一种预后不佳的疾病,在我们的POU,主要是由于较晚的表现。为了改善预后,重点应放在识别危险迹象,以确保早期诊断和转诊。我们建议在儿童疾病综合管理(IMCI)策略中增加儿童癌症的危险信号,以提高儿童癌症的早期识别和诊断。
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来源期刊
CiteScore
0.60
自引率
0.00%
发文量
21
审稿时长
12 weeks
期刊最新文献
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