Abstract: Objective To assess the outcomes of stage 4 neuroblastomas (NB), and analyze the associated prognostic factors. Methods Ninety-five children with stage 4 NB were retrospectively analyzed. The curative effects and related factors affecting prognosis were compared between NB09 protocol group (n=40) and non-NB09 group (n=55). The median age of 95 children was 48 months (4-136 months), and the median follow-up time was 21 months (4-179 months). Results The total survival rate and progression free survival rate were significantly better in NB09 group than those of non-NB09 group (χ2=6.916 and 0.025， P＜0.05). The univariate analysis showed that treatment plan, pathologival type, bone marrow involvement>20%, N-MYC amplification, surgical extent＜90%, non-therapy of cis-retinoic acid, LDH>1 000 U/L and very good partial remission (VGPR) were the influencing factors for the prognosis in children (P＜0.05). Multivariate regression analy⁃ sis showed that bone marrow involvement>20% was the bad independent prognostic factors for stage 4 patients. Conclusion Children with stage 4 NB treated according to the NB09 protocol have a better prognosis. Children of stage 4 neuro⁃ blastomas with bone marrow involvement >20% have a bad prognosis to current treatment.

Key words: neuroblastoma, therapy, prognosis, child, NB09 protocol