Clinical Prognostic Significance Of Neuroblastoma:A Meta-analysis

ObjectiveRetrospective cohort analysis of clinical cases with prognosis correlation of neuroblastoma was Collected.Systematical review method was applied to make a comprehensive quantitative analysis of the value of INSS staging,pathological type,bone metastases or not,N-myc amplification or not,serum NSE increased or not,the operation was completely removed or not,first diagnosis age,and the primary site,and other neuroblastoma clinical prognostic factors,evaluated the impact of the above factors on the survival of neuroblastoma patients more objectively.MethodsWe searched CNKI,WanFang,VIP,Pubmed,EMBase,the Cochrane Library to collect the prognosis of children with neuroblastoma clinical case retrospective cohort analysis of correlation.The retrieval time from building the database was until Dec.31,2018.After two reviewers independently screened the literature,extracted data and evaluated the quality of the included studies,the extracted data were statistically analyzed using the Review Manager software.ResultsA total of 10 studies were included,consisting of China,Japan and Italy.All the studies were retrospective cohort studies.A total of 988 cases were reported,including 556 males and 432 females,with a male to female ratio of 1.29.The time of publication was from 2003 to 2018.Univariate analysis of kaplan-metier survival curve and meta-analysis of neuroblastoma prognosis showed that stage ? and ? patients in INSS stages [HR=2.20,95%CI(1.04,4.66),P=0.04],patients with neuroblastoma pathologic examination [HR=11.97,95%CI(2.33,61.58),P=0.003],and patients with N-myc gene amplification [HR=7.73,95%CI(2.43,24.60),P=0.0005]Patients with elevated serum NSE and >100ug/L [HR=2.74,95%CI(1.67,4.48),P<0.0001] had a higher risk of death,which was an adverse prognostic factor.Multivariate analysis based on COX proportional risk model and meta-analysis of neuroblastoma prognosis showed that patients in stage ? and ? of INSS stage [HR=2.98,95%CI(1.47,6.07),P=0.003] and patients without complete tumor resection [HR=2.63,95%CI(1.77,3.90),P<0.00001] had a higher risk of death and were independent prognostic factors.Meta-analysis based on some prognostic factors of 5-year total survival and 5-year survival showed that in INSS stage ? and ? patients [RR=7.19,95%CI(3.64,14.20),P<0.00001],patients over 18 months of age at initial diagnosis [RR=2.31,95%CI(1.56,3.40),P<0.0001],and patients whose primary site was located in the adrenal region [RR=2.71,95%CI(1.61,4.55),P<0.0002] 5-year survival rate is relatively low,indicating poor prognosis.ConclusionThe prognosis of neuroblastoma patients was affected by their INSS stage,pathological type,N-myc amplification or not,serum NSE increased or not,the operation was completely removed or not,age of first diagnosis and primary site.Stage ?,? and pathological examination in INSS staging revealed neuroblastoma,amplification of N-myc gene,elevated serum NSE with >100ug/L,incomplete surgical resection of the tumor,initial diagnosis age over 18 months,and primary tumor location in the adrenal gland as adverse prognostic factors.INSS stage and complete tumor resection were independent prognostic factors.