·To analyze the factors affecting the survival and prognosis of the children with medium-, high-, and very high-risk neuroblastoma (NB) in stage Ⅲ?Ⅳ after radiation therapy.Methods
·A total of 132 cases of neuroblastoma patients from 2008 to 2018 who received local radiotherapy in the Department of Hematology and Oncology, Shanghai International Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, and the Department of Radiation Oncology, Renji Hospital and Xinhua Hospital were included. Treatment options included chemotherapy, surgery, autologous bone marrow transplantation (ABMT), radiotherapy, and later 13-cis-RA maintenance therapy. SPSS 19.0 software was used for the calculation of event-free survival (EFS) and overall survival (OS) rates, as well as univariate and multivariate survival analysis.Results
·By the end of the follow-up, the EFS rates for the all patients were 87.41% in 1 year, 55.25% in 2 years, 45.02% in 3 years, and 38.67% in 5 years, and the OS rates were 96.02% in 1 year, 83.54% in 2 years, 72.15% in 3 years, and 57.79% in 5 years, respectively. The medium follow-up time was 40.3 months. Univariate survival analysis suggested that the staging, risk grouping, brain metastasis or not, blood lactic acid dehydrogenase and serum ferritin levels were associated with EFS and OS (P<0.05). The presence or absence of bone marrow infiltration was a related factor of EFS (P=0.007), but not OS-related. Factors such as the child′s gender, whether the child was treated with ABMT, the amplification of MYCN proto-oncogene, and the presence of liver metastasis had no significant correlation with EFS or OS. Multivariate survival concluded that brain metastasis was an independent prognosis factor for EFS and OS.Conclusion
·The amplification of MYCN gene and ABMT treatment may not significantly affect the radiotherapy efficacy and overall survival of stage Ⅲ?Ⅳ NB children. However, the presence of brain metastasis is an independent prognostic factor related to survival and disease progression after radiotherapy.