RESUMEN
Little information is available about survival of high-risk pediatric neuroblastoma patients in developing countries. We aimed to assess survival among high-risk pediatric neuroblastoma patients in La Plata, Argentina. Individuals eligible for our cohort were aged <20 yr when diagnosed with high-risk neuroblastoma and received cancer-directed therapy including stem cell transplantation at Hospital de Niños Sor Maria Ludovica between February 1999 and February 2015. We estimated overall survival probabilities using an extended Kaplan-Meier approach. Our study population comprised 39 high-risk neuroblastoma patients, of whom 39% were aged >4 yr at diagnosis, 54% were male, and 62% had adrenal neuroblastoma. We observed 18 deaths, and the median survival time of our study population was 1.7 yr. The five-yr overall survival probability was 24% (95% CL: 10%, 41%). In contrast, five-yr survival of high-risk neuroblastoma patients ranges between 23% and 76% in developed countries. Survival among high-risk neuroblastoma patients is generally poor regardless of geographic location, but our results illustrate dramatically worse survival for patients in a developing country. We speculate that the observed survival differences could be attenuated or eliminated with improvements in treatment and supportive care, but addressing these issues will require creative solutions because of resource limitations.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias del Mediastino/mortalidad , Neuroblastoma/mortalidad , Neoplasias Retroperitoneales/mortalidad , Adolescente , Neoplasias de las Glándulas Suprarrenales/terapia , Argentina/epidemiología , Niño , Preescolar , Países Desarrollados , Países en Desarrollo , Femenino , Estudios de Seguimiento , Disparidades en el Estado de Salud , Humanos , Lactante , Recién Nacido , Masculino , Neoplasias del Mediastino/terapia , Neuroblastoma/terapia , Pronóstico , Neoplasias Retroperitoneales/terapia , Riesgo , Trasplante de Células Madre , Análisis de Supervivencia , Adulto JovenRESUMEN
We are reporting 16 cases of toxocariasis found in a two year period. Mean age was 2 years and 9 months. Sex distribution was 1:1. Thirteen (81 per cent) children presented pica, 8 (50 per cent) had pets at home, 10 (62.5 per cent presented anemia and long standing fever, and all eosinophilic leukocytosis. Fundoscopy was normal in all. Toxocara antibodies (Through ELISA) were increased in all of them. High resolution ultrasonography revealed hypoechoic areas in the liver in 50 per cent of the cases. Therapeutic response was good, the clinical signs and symptoms disappearing at the end of treatment. The eosinophilic leukocytosis, ELISA serum positivity for toxocara and ultrasound findings persisted approximately for a year. Toxocariasis is a common parasitosis in our setting. It must be regarded as the first diagnosis when confronted with eosinophilic leukocytosis and abnormal liver findings by ultrasound.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Larva Migrans Visceral/complicaciones , Hígado/parasitología , Anticuerpos Antihelmínticos/análisis , Estudios de Seguimiento , Larva Migrans Visceral , Larva Migrans Visceral/patología , HígadoRESUMEN
We are reporting 16 cases of toxocariasis found in a two year period. Mean age was 2 years and 9 months. Sex distribution was 1:1. Thirteen (81 per cent) children presented pica, 8 (50 per cent) had pets at home, 10 (62.5 per cent presented anemia and long standing fever, and all eosinophilic leukocytosis. Fundoscopy was normal in all. Toxocara antibodies (Through ELISA) were increased in all of them. High resolution ultrasonography revealed hypoechoic areas in the liver in 50 per cent of the cases. Therapeutic response was good, the clinical signs and symptoms disappearing at the end of treatment. The eosinophilic leukocytosis, ELISA serum positivity for toxocara and ultrasound findings persisted approximately for a year. Toxocariasis is a common parasitosis in our setting. It must be regarded as the first diagnosis when confronted with eosinophilic leukocytosis and abnormal liver findings by ultrasound. (Au)