Multivariate evaluation of prognostic factors in localized neuroblastoma

A multitude of risk factors has been described for patients with neuroblastoma. Little is known about the mutual interrelationship of these factors and their impact on patients with localized disease only.

We investigated the possible influence of 37 variables univariately on event-free survival (EFS) in 308 consecutive patients with neuroblastoma stages I-III using Kaplan-Meier estimates. The chi 2 test was applied to detect nonrandom correlations, and the Cox's regression model was used for the multivate evaluation of identified factors.

Seventeen factors appeared to influence EFS in stage I-III patients (p < 0.05, log-rank > 3.84), whereas 10 factors were found in the subgroup of stage III patients with midline crossing tumors (= stage III*, n = 128). The majority of univariately identified risk factors showed a nonrandom correlation to several others (p < 0.05). The multivariate analysis according to Cox selected for the patients with stages I-III the factors lactate dehydrogenase (LDH) (p = 0.0011), resectability (p = 0.0167), weight loss (p = 0.0185), tumor extension beyond midline (p = 0.0207), and age (p = 0.0233). For stage III* patients the model identified the factors LDH (p = 0.0089), weight loss (p = 0.0135), resectability (p = 0.0408), and age (p = 0.0700). The identification of these independent risk factors permitted the description of risk groups with EFS ratios after > 6 years between 22% and 96%.

Risk estimation of high discriminating power is possible for patients with localized neuroblastoma using simple, readily available clinical data.