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. 2023 Apr 12;21(1):130.
doi: 10.1186/s12957-023-03011-y.

Metastasis pattern and prognosis in children with neuroblastoma

Shan Liu #  1   2 , Weimin Yin #  1   2 , Yaobin Lin #  3 , Sihan Huang  1   2 , Shufang Xue  1   2 , Gaoyuan Sun  1   2 , Chengyi Wang  4   5
Affiliations

Metastasis pattern and prognosis in children with neuroblastoma

Shan Liu et al. World J Surg Oncol. .

Abstract

Background: We aimed to investigate the different metastases and prognoses of neuroblastoma (NB) and determine the risk factors of metastasis.

Method: Data of 1224 patients with NB were obtained from the Surveillance, Epidemiology and End Results database (2010-2018). Pearson's chi-square test, Kaplan-Meier analysis, multivariable logistic regression and Cox regression analysis were used to determine the factors associated with prognosis.

Results: The overall incidence of NB was an age-adjusted rate of 8.2 patients per 1,000,000 children. In total, 1224 patients were included in our study, with 599 patients (48.9%) exhibiting distant metastases. Compared to patients with non-metastatic NB, a greater proportion of patients with metastatic NB were under 1 year, male, had an adrenal primary site, unilateral tumour, a tumour size > 10 cm, neuroblastoma-not otherwise specified (NB-NOS), second malignant neoplasms and were more likely to choose radiotherapy and chemotherapy. Multivariate Cox regression showed that metastasis was an independent risk factor for overall survival (OS) and cancer-specific survival (CSS). The survival rate of non-metastatic patients with NB was better than those with metastasis (OS: hazard ratio (HR): 0.248, P < 0.001; CSS: HR: 0.267, P < 0.001). The bone and liver were the two most common isolated metastatic sites in NB. However, no statistical difference was observed in OS and CSS between the only bone metastasis group, only liver metastasis group and bone metastasis combined with liver metastasis group (all P > 0.05). Additionally, age at diagnosis > 1 year (odds ratio (OR): 3.295, P < 0 .001), grades III-IV (OR: 26.228, P < 0 .001) and 5-10 cm tumours (OR: 1.781, P < 0 .001) increased the risk of bone metastasis of NB. Moreover, no surgical treatment (OR: 2.441, P < 0 .001) increased the risk of liver metastasis of NB.

Conclusion: Metastatic NB has unique clinicopathological features, with the bone and liver as the most common single metastatic sites of NB. Therefore, more aggressive treatment is recommended for high-risk children with NB displaying distant metastases.

Keywords: Cancer-specific survival; Distant metastases; Neuroblastoma; Overall survival; SEER.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the overall study design
Fig. 2
Fig. 2
The age-adjusted incidence of NB in the USA (2010–2018). Abbreviations: NB, neuroblastoma
Fig. 3
Fig. 3
Kaplan-Meier curves for OS and CSS in NB patients with a single site of metastasis. A, B OS and CSS between patients with and without bone metastasis. C, D OS and CSS between patients with and without liver metastasis. Abbreviations: OS, overall survival; CSS, cancer-specific survival; NB, neuroblastoma
Fig. 4
Fig. 4
Kaplan–Meier curves for OS and CSS of patients with NB at different metastasis sites. A, B The survival difference among the different metastasis sites in patients with NB. C, D The survival difference among the different numbers of metastasis sites in patients with NB. Abbreviations: OS, overall survival; CSS, cancer-specific survival; NB, neuroblastoma
Fig. 5
Fig. 5
The risk factors for the different primary sites in the developing metastatic disease. A Bone metastasis. B Liver metastasis. Abbreviations: SMN, second malignant neoplasms; CI, confidence interval; OR, odds ratio; NOS, not otherwise specified
See this image and copyright information in PMC

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