Overall survival for neuroblastoma in South Africa between 2000 and 2014.
BACKGROUND
Outcome data for neuroblastoma in sub-Saharan Africa are minimal, whereas poor outcome is reported in low- and middle-income countries. A multi-institutional retrospective study across South Africa was undertaken to determine outcome.


METHODS
Patients treated between January 2000 and December 2014 in nine South African pediatric oncology units were included. Kaplan-Meier curves and Cox regression models were employed to determine two-year survival rates and to identify prognostic factors.


RESULTS
Data from 390 patients were analyzed. The median age was 39.9 months (range, 0-201 months). The majority presented with stage 4 disease (70%). The main chemotherapy regimens were OPEC/OJEC (44.8%), St Jude NB84 protocol (28.96%), and Rapid COJEC (22.17%). Only 44.4% had surgery across all risk groups, whereas only 16.5% of high-risk patients received radiotherapy. The two-year overall survival (OS) for the whole cohort was 37.6%: 94.1%, 81.6%, and 66.7%, respectively, for the very-low-risk, low-risk, and intermediate-risk groups and 27.6% for the high-risk group (P < 0.001, 95% CI). The median survival time for the whole group was 13 months (mean, 41.9 months; range, 0.1-209 months). MYCN-nonamplified patients had a superior two-year OS of 51.3% in comparison with MYCN-amplified patients at 37.3% (P = 0.002, 95% CI).


CONCLUSIONS
Limited disease had an OS comparable with high-income countries, but advanced disease had a poor OS. South Africa should focus on early diagnosis and implementation of a national protocol with equitable access to treatment.
['Van Heerden|Jaques|J|0000-0002-4502-1169', 'Hendricks|Marc|M|', 'Geel|Jennifer|J|0000-0001-8792-3251', 'Sartorius|Benn|B|', 'Hadley|G P|GP|0000-0002-2459-7118', 'Du Plessis|Jan|J|', 'Büchner|Ané|A|', 'Naidu|Gita|G|', 'Van Emmenes|Barry|B|', 'Van Zyl|Anel|A|', 'Kruger|Mariana|M|0000-0002-6838-0180']
D000971:Antineoplastic Combined Chemotherapy Protocols D002648:Child D002675:Child, Preschool D015897:Comorbidity D065426:Cytoreduction Surgical Procedures D003906:Developing Countries D005784:Gene Amplification D016259:Genes, myc D006297:Health Services Accessibility D006801:Humans D007223:Infant D007231:Infant, Newborn D053208:Kaplan-Meier Estimate D009367:Neoplasm Staging D009447:Neuroblastoma D011379:Prognosis D016016:Proportional Hazards Models D011878:Radiotherapy D012189:Retrospective Studies D013019:South Africa D033581:Stem Cell Transplantation D015996:Survival Rate D014182:Transplantation, Autologous
overall survival neuroblastoma South Africa outcomes