Clinical prognostic factors in 1277 patients with neuroblastoma: results of The European Neuroblastoma Study Group 'Survey' 1982-1992

In 1982 the European Neuroblastoma Study Group (ENSG) established a prospec tive registry for patients with newly diagnosed neuroblastoma ('The ENSG Su rvey'). Clinical information was collected primarily to: (a) establish an E NSG database; and (b) investigate prognostic factors in neuroblastoma. This paper summarises the results of the survey. By 1992, 1277 patients with a median age of 26 months (range: 0-289 months), gender ratio of 1.19 M:F had been registered from 30 centres. The median followup of survivors is 9.7 y ears (range: 1-14 years). Overall 5-year survival (S) is 45% (95% CI 42-48% ), and event-free survival (EFS) is 43% (95% CI 40-45%). For both survival and EFS the key established prognostic factors, stage and age, are highly s ignificant (P < 0.001). In particular, patients under 1 year of age at diag nosis, whatever the disease stage, had a more favourable prognosis than old er patients; stage 2 (EFS 93% (95% (CI 85-97) versus 76% (95% CI 67-86), P = 0.02), stage 3 (EFS 91% (95% CI 82-96) versus 52% (95% CI 44-60), P < 0.0 01) and stage 4 (EFS 59% (95% CI 48-69) versus 16% (95% CI 13-19), P < 0.00 1). Multivariate analysis established that the anatomical location of the p rimary tumour (i.e. abdominal versus other sites) and primary tumour volume also conferred a statistically significant difference. In stage 4 disease the 20% of patients without demonstrable bone marrow involvement had a more favourable prognosis than those with infiltrated marrow (EFS 36% (95% CI 1 3-19) versus 16% (95% CI 29-45), P < 0.001). Urine catecholamine metabolite levels (raised versus normal), histology (ganglioneuroblastoma versus neur oblastoma) and gender had no significant effect on outcome after stage and age were accounted for. 5-year survival following first relapse is only 5.6 % (95% CI 2.8-8.4). This ENSG Survey provides secure data for future compar isons with new prognostic factors and treatment programmes. (C) 2000 Elsevi er Science Ltd. All rights reserved.