# Prognostic factors of neuroblastoma in limited-resource settings

## TL;DR

This study identifies elevated LDH levels and stage 4 as risk factors for death in children with neuroblastoma in low-income countries.

## Contribution

The study provides a viable risk classification for neuroblastoma in limited-resource settings using LDH levels and staging.

## Key findings

- LDH ≥640.5 U/L was a significant risk factor for death (HRa 2.49; p<0.001).
- Stage 4 neuroblastoma was associated with increased mortality (HRa 1.67; p=0.047).
- Overall survival was 32.4%, with distinct survival curves based on LDH and staging.

## Abstract

This study aimed to analyze survival and risk factors for death in children with neuroblastoma that may contribute to a viable risk classification for low-income countries.

A historic cohort involving patients under 19 years of age with neuroblastoma was followed at a reference center in Northeast Brazil between July 2005 and July 2020. Data on sociodemographic, were collected. The outcomes studied were recurrence, disease progression, and five-year mortality. Multivariate analysis of Cox proportional hazards for death was performed. Overall and eventfree survivals were evaluated using the Kaplan-Meier method and the comparison between the groups studied, by the log-rank test.

Patients (n=126) were predominantly female with a median age of 26.5 months. Most presented primary adrenal, tumor stage 4 according to the International Neuroblastoma Staging System, unfavorable histology, and median serum lactate dehydrogenase (LDH) levels of 640.5 U/L. LDH≥640.5 U/L (hazard ratio [HRa] 2.49; 95% confidence interval [CI] 1.57–3.95; p<0.001) and stage 4 (HRa 1.67; 95%CI 1.00–2.78; p=0.047) were identified as risk factors for death. The overall survival was 32.4%, showing distinct curves regarding LDH serum levels and staging (log-rank p<0.05); the event-free survival was 26.3%.

Elevated LDH serum levels were a risk factor for five-year mortality, and can be utilized as a prognostic marker in resource-limited settings.