Neuroblastoma in Iran: An Experience of 32 Years at a Referral Childrens Hospital

  • Published : 2013.05.30


Background: This survey aim was to evaluate the epidemiology and outcomes of neuroblastoma patients in one the most important children referral hospitals in Iran as a model from developing countries. Materials and Methods: This retrospective, non-randomized analytic study was conducted on 219 newly diagnosed neuroblastoma cases. Results: The age of patients ranged from 1-156 months with the average of $40.5{\pm}2.44$, with a male/female ratio of 1.9/1. Of the total, 172 (78.5%) were children and 47 (21.5%) were infants The adrenals were the most common primary site (60%). Stage 4 at diagnosis accounted for about 54% of all enrolled patients. Infants had significantly better cumulative survival ($85{\pm}8%$) than children ($33{\pm}7%$) during the follow up period and the survival rate improved from $33{\pm}7%$ in 1974-1994 to $58{\pm}9%$ in 1995-2005. Conclusions: This study indicates that our patient population with neuroblastomas tends to have more advanced disease, perhaps with poor biologic markers, but our analysis shows that the outcomes have improved over 32 years although the overall survival of Iranian neuroblastoma patients is still lower than developed countries. Late diagnosis, inability to determine risk group during the years of study and using single protocol for all enrolled patients can be the reasons of lower survival rate.


  1. Bernstein ML, Leclerc JM, Bunin G, et al (1992). A populationbased study of neuroblastoma incidence, survival, and mortality in North America. J Clin Oncol, 10, 323-9.
  2. Bhatnagar SN, Sarin YK (2012). Neuroblastoma: a review of management and outcome. Indian J Pediatrics, 79, 787-92.
  3. Brodeur GM (2011). Knowing your ABCCs: novel functions of ABCC transporters. J Natl Cancer Inst, 103, 1207-8.
  4. Chen QR, Song YK, Wei JS, et al (2008). An integrated crossplatform prognosis study on neuroblastoma patients. Genomics, 92, 195-203.
  5. Cornero A, Acquaviva M, Fardin P, et al (2012). Design of a multi-signature ensemble classifier predicting neuroblastoma patients' outcome. BMC Bioinformatics, 13, 13.
  6. David L, Baker MLS, Susan L, et al (2010). Outcome after reduced chemotherapy for intermediate-risk neuroblastoma. N Engl J Med, 363, 1313-23.
  7. Hara J ( 2012). Development of treatment strategies for advanced neuroblastoma. Int J Clinical Oncology, 17, 196-203.
  8. Harder T, Plagemann A, Harder A (2010). Birth weight and risk of neuroblastoma:a meta-analysis. Int J Epidemiol, 39, 746-56.
  9. Henderson TO, Bhatia S, Pinto N, et al (2011). Racial and ethnic disparities in risk and survival in children with neuroblastoma: a children's oncology group study. J Clin Oncol, 29, 76-82.
  10. Hiyama E (2008). Neuroblastoma screening in Japan: populationbased cohort study and future aspects of screening. Ann Acad Med Singapore, 37, 88-91.
  11. Lee A (2012). Neuroblastoma: the challenge remains. Singapore Med J, 53, 1-2.
  12. Ries LAG, Krapcho M, Mariotto A, et al (2007). SEER cancer statistics review, 1975-2004. National Cancer Institute, 2007.
  13. Schilling FH, Spix C, Berthold F, et al (2002). Neuroblastoma screening at one year of age. N Engl J Med, 346, 1047-53.
  14. Stat B (2011). Neuroblastoma: five-year survival. J Natl Cancer Inst, 103, 1220.
  15. Sung KW, Ahn HS, Cho B, et al (2010). Efficacy of tandem high-dose chemotherapy and autologous stem cell rescue in patients over 1 year of age with stage 4 neuroblastoma: the Korean Society of Pediatric Hematology-Oncology experience over 6 years (2000-2005). J Korean Med Sci, 25, 691-7.
  16. Tan C, Sabai SM, Tin AS, Quah TC, Aung L (2012), Neuroblastoma: experience from National University Health System, Singapore (1987-2008). Singapore Med J, 53, 19-25.
  17. Vermeulen J, De Preter K, Naranjo A, et al (2009). Outcome Prediction of children with neuroblastoma using a multigene expression signature, a retrospective SIOPEN/COG/GPOH study. Lancet Oncol, 10, 663-71.
  18. Weinstein JL, Katzenstein HM, Cohn SL (2003). Advances in the diagnosis and treatment of neuroblastoma. Oncologist, 8, 278-92.
  19. Wiangnon S, Veerakul G, Nuchprayoon I, et al (2011). Childhood cancer incidence and survival 2003-2005, Thailand: study from the Thai pediatric oncology group. Asian Pac J Cancer Prev, 12, 2215-20.

Cited by

  1. Epidemiologic Survey of Infantile Cancer in Iran based on the Data of the Largest Pediatric Cancer Referral Center (Ali-Asghar Children Hospital), 1996-2005 vol.15, pp.3, 2014,
  2. Expression of Ki-67, p53 and VEGF in Pediatric Neuroblastoma vol.15, pp.7, 2014,
  3. Clinicopathological Features of Adrenal Tumors: a Ten-year Study in Yazd, Iran vol.16, pp.12, 2015,
  4. A Phase I Study of the Anti-Idiotype Vaccine Racotumomab in Neuroblastoma and Other Pediatric Refractory Malignancies vol.62, pp.12, 2015,
  5. Update on Adrenal Tumours in 2017 World Health Organization (WHO) of Endocrine Tumours vol.28, pp.3, 2017,