PROGNOSIS OF NEUROBLASTIC TUMORS IN CHILDREN

A retrospective analysis of 26 children with neuroblastic tumours trea ted at the University Hospital of the West Indies (UHWI) between 1970 and 1991 was undertaken to evaluate factors affecting prognosis. The p eak incidence was between 48 months and 60 months of age, and 75% of t he deaths occurred in children older than 3 years. The abdomen was the most common site of the tumours 79% of which were from the adrenal gl and and carried a dismal outcome. Other sites were thoracic, pelvic an d cervical. Extra-adrenal tumours have a good outcome even when the hi stology is unfavourable; 92% of the tumours were in Stages III or IV a t the time of initial presentation. Stage IV disease accounted for all but one of the deaths. Of the 8 children with favourable histology (g anglioneuroma or well-differentiated ganglioneuroblastoma), only one ( 12.5%) died, wheras of the remaining 18 cases with unfavourable histol ogy (neuroblastoma and undifferentiated ganglioneuroblastoma), eleven (61.1%) died. When managed by surgery alone or with adjuvant chemo- an d/or radio-therapy, only 36.4% succumbed while all 4 children with che motherapy only died. Ten children are alive without disease for more t han three years post-therapy. A scoring system was designed which take s into account the factors influencing the outcome in neuroblastic tum ours, namely, age, location, stage and histological types of the tumou rs and therapy. All the children with a score of 21 or less survived, whereas all those with scores of 22 or above succumbed. This underline s the multifactorial influences on the final outcome of the neuroblast ic tumours.