Neuroblastoma by Stage at Diagnosis and Other Prognostic Factors: The Results of the BENCHISTA Italian Project-A Population-Based Study.
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Background: Neuroblastoma is the most common embryonal cancer. Since several population-based studies in Europe have revealed differences in 5-year survival across countries and regions. Objectives: We principally investigated the impact of stage at diagnosis on survival in Italy. Methods: Data were obtained from 26 population-based cancer registries (PBCRs), covering 319 cases (ages 0-14) diagnosed between 2013 and 2017, representing about 80% of the national population. Stage was classified according to the Toronto guidelines. Information on treatment and treating hospitals was also collected. Stage at diagnosis was further refined using probabilistic linkage with the Italian Neuroblastoma Registry (RINB). Results: Overall survival (OS), defined as all-cause mortality, was estimated using the Kaplan-Meier method. Most patients presented with stage M disease (37%), while a small proportion remained unclassified (2%). Three-year survival analysis showed significant differences between stages, ranging from >95% in localised (stage I) and MS stages to 78% in stage M (stage IV). No significant disparity across the Italian regions was observed in stage distribution or survival. Surgery and radiotherapy treatments of neuroblastoma were mostly centralized in the Centre and North of Italy. However, the cross-regional health migration from the South was limited to, and interpreted as appropriate for, high-volume centres. Conclusions: This population-based study highlights the high quality of care provided to children with neuroblastoma by an effective national clinical network. Compared with previous studies, we observed very limited variation across regions. A national childhood cancer registry remains essential to obtain a comprehensive picture of the country.