@article{3205362,
    title = "Survival patterns of childhood neuroblastoma: an analysis of clinical data from Southern-Eastern European countries.",
    author = "Karalexi, Maria A. and Servitzoglou, Marina and Papadakis, Vassilios and Kachanov, Denis and Česen Mazič, Maja and Baka, Margaret and Moschovi, Maria and Kourti, Maria and Polychronopoulou, Sofia and Stiakaki, Eftichia and Hatzipantelis, Emmanuel and Dana, Helen and Stefanaki, Kalliopi and Malama, Astero and Themistocleous, Marios S. and Strantzia, Katerina and Shamanskaya, Tatyana and Bouka, Panagiota and Panagopoulou, Paraskevi and Kantzanou, Maria and Ntzani, Evangelia and Dessypris, Nick and Petridou, Eleni Th",
    journal = "European Journal of Cancer Prevention: The Official Journal of the European Cancer Prevention Organisation (ECP)",
    year = "2020",
    issn = "0959-8278",
    doi = "10.1097/CEJ.0000000000000614",
    abstract = "The prognosis of children with neuroblastoma (NBL) can be dismal with significant variations depending on the stage and biology of the tumor. We assessed the  event-free (EFS) and overall (OS) survival using harmonized data from three  Southern-Eastern European (SEE) countries. Data for 520 incident NBL cases  (2009-2018) were collected from Greece, Slovenia and Russia. Kaplan-Meier curves  were fitted, and EFS/OS were derived from Cox proportional models by study variables  including the protocol-based risk-group (low/observation, intermediate, high). Over  one-third of cases were coded in the high-risk group, of which 23 children (4.4%)  received treatment with anti-ganglioside 2 (GD2) mAb. Survival rates were inferior  in older (OS 5-year; 1.5-4.9 years: 61%; EFS 5-year; 1.5-4.9 years: 48%) compared to  children younger than 1.5 years (OS 5-year; <1.5 years: 91%; EFS 5-year; <1.5 years:  78%). Predictors of poor OS included stage 4 (hazard ratio, HROS: 18.12, 95%  confidence intervals, CI: 3.47-94.54), N-myc amplification (HROS: 2.16, 95% CI:  1.40-3.34), no surgical excision (HROS: 3.27, 95% CI: 1.91-5.61) and  relapse/progression (HROS: 5.46, 95% CI: 3.23-9.24). Similar unfavorable EFS was  found for the same subsets of patients. By contrast, treatment with anti-GD2  antibody in high-risk patients was associated with decreased risk of death or  unfavorable events (HROS: 0.11, 95% CI: 0.02-0.79; HREFS: 0.19, 95% CI: 0.07-0.52).  Our results confirm the outstanding prognosis of the early NBL stages, especially in  children <1.5 years, and the improved outcomes of the anti-GD2 treatment in  high-risk patients. Ongoing high-quality clinical cancer registration is needed to  ensure comparability of survival across Europe and refine our understanding of the  NBL biology."
}