Neuroblastoma: Outcome over a 14 year period from a tertiary care referral centre in India ☆ , ☆☆ Sandeep Agarwala a, ⁎, Ankur Mandelia a , Sameer Bakhshi b , M. Srinivas a , Minu Bajpai a , Arun K. Gupta c , Devendra K. Gupta a , Veereshwar Bhatnagar a a Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India b Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi-110029, India c Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi-110029, India abstract article info Article history: Received 28 July 2013 Received in revised form 18 March 2014 Accepted 20 March 2014 Key words: Neuroblastoma Treatment Outcome Survival Purpose: To evaluate the outcome of children with neuroblastoma (NB) from a tertiary care referral centre in India. Method: 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 1–132 months (median 36) were enrolled. Only 38 (26.4%) children were below 12 months. 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%); 4 s 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 b 12 months of age [95 CI 51.8–82.0] and CR was achieved in 57.9%, while for those N 12 months 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 4 s [95 CI 48.2–95.6] and CR was achieved in 75%. Conclusion: 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). © 2014 Elsevier Inc. All rights reserved. Neuroblastoma (NB), the most frequent extra-cranial childhood tumor, is characterized by various clinical presentations and diverse prognosis of its subsets [1]. While in some patients the tumor is successfully treated with surgery alone [2], or may regress spontane- ously [3], the chance of cure in children older than one year with metastatic disease remains poor [4]. Although the probability of survival for children with neuroblastoma has improved over time, even the best published results do not parallel those obtained for some other childhood malignancies like Wilms tumors and germ cell tumors [5]. While the outcome for Stages 1 and 2 NB is now almost 100%, those for older children with Stage 4 disease, especially if MYCN amplified, remain poor. Few studies have documented this improve- ment by reporting large series of patients diagnosed over a long period [6–10]. Reports on the outcome of children with neuroblastoma from developing countries such as India are limited [11–15]. Low socio- economic background, coupled with the unfavourable outcome associated with advanced stage disease, contributes to a large dropout rate [15]. The aim of this study was to evaluate the outcome of children with neuroblastoma treated in the solid tumor clinic of the Cancer Center of All India Institute of Medical Science, New Delhi, which is a tertiary care referral centre. 1. Patients and methods 1.1. Eligibility All patients with neuroblastoma enrolled in the solid tumor clinic from October 1996 through July 2009 were included in this study and evaluated. Patients who had come only for an opinion, or those who Journal of Pediatric Surgery 49 (2014) 1280–1285 ☆ Conflict of interest: Nil. ☆☆ Source of funding: Nil. ⁎ Corresponding author. Tel.: +91 11 26593309; fax: +91 11 26588641. E-mail address: sandpagr@hotmail.com (S. Agarwala). http://dx.doi.org/10.1016/j.jpedsurg.2014.03.017 0022-3468/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg