Epidemiology and outcomes in pediatric neuroblastoma: a US population-based study

Neuroblastoma is a heterogeneous pediatric malignancy with variable outcomes. This study aimed to evaluate survival outcomes and identify independent prognostic factors using a large population-based cohort.

The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 863 patients diagnosed with neuroblastoma between 2000 and 2017. Multivariable Cox proportional hazards regression was performed to assess predictors of overall and cancer-specific mortality.

The cohort included nearly equal numbers of males and females, with most patients diagnosed before 10 years of age. The majority of patients were non-Hispanic White, followed by Hispanic and non-Hispanic African American patients. In univariate analysis, race/ethnicity showed differences in mortality; however, these were not significant after multivariable adjustment. Increasing age at diagnosis was strongly associated with worse survival, with infants (<1 year) demonstrating the best outcomes and adolescents (10-19 years) the highest mortality risk. Distant metastatic disease was independently associated with increased mortality. Surgical resection was associated with improved overall survival, whereas chemotherapy was associated with higher mortality, likely reflecting confounding by indication due to treatment selection in high-risk disease.

Age at diagnosis and disease stage are the strongest independent predictors of survival in pediatric neuroblastoma. Race/ethnicity was not independently associated with outcomes after adjustment. Observed associations between chemotherapy and mortality likely reflect underlying disease severity rather than treatment effect.