Clinical patterns, treatment outcomes and determinant factors in children with neuroblastoma in a tertiary referral hospital in Ethiopia

Abstract

Neuroblastoma is the most common extra cranial solid tumor in children, and causes 15% of childhood cancer deaths. With increased-intensity treatment in developed countries, the five-year survival rate remains around 60%. This study examined the clinical patterns, treatment outcomes, and contributing factors in children diagnosed with neuroblastoma in Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted on one hundred and one children who met the inclusion criteria, using a structured data collection format. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) version 26. A p-value < 0.05 was considered statistically significant. Chi-square test, log-rank test, and Cox regression were used to assess associations among the variables of interest. Kaplan-Meier survival estimates were utilized for overall survival (OS) and event-free survival (EFS) analysis. Results A total of one hundred and one (101) children diagnosed with neuroblastoma met the inclusion criteria, with an equal sex distribution. The majority of cases, 74.3% (n = 75), were above18 months, with a mean age of 4.00 ± 3.28 years. The median duration from symptom onset to presentation at the oncologic treatment center was 8 weeks, with an interquartile range (IQR) of 4 to 12 weeks. The most common primary tumor site was intra-abdominal masses, present in 77.2% (n = 77) of cases. At presentation, tumor staging was predominantly advanced, with 59.4% (n = 60) at stage 4 and 15.8% (n = 16) at stage 3. Treatment was initiated in 76.2% (n = 77) of patients, with 66.3% (n = 67) receiving treatment with curative intent. Approximately 58.4% (n = 59) of patients were lost to follow-up. The 1-year overall survival (OS) and event-free survival (EFS) estimates were 72.4% and 11.5%, respectively, while the 5-year OS and EFS estimates were 48.5% and 5.5%, respectively, among patients with known status during the study period. Conclusion Our study found that the average time from symptom onset to presentation at an oncologic treatment center was 8 weeks. More than three-quarters of the cases presented with advanced-stage disease. The 1-year and 5-year overall survival (OS) rates for children with neuroblastoma in our setting were considerably lower than those reported in other studies.