Abstract
Background : The present study aimed to identify the predictive
factors of acute respiratory events (ARE), including severe hypoxia,
during initial induction chemotherapy in patients with newly diagnosed
advanced neuroblastoma.
Method : The medical records of 75 consecutive patients in whom
stage III or IV neuroblastoma was newly diagnosed between January 2003
and December 2018 at two medical institutions were retrospectively
reviewed. The outcome was ARE concomitant with severe hypoxia between
the first and 14th days of initial induction chemotherapy. Severe
hypoxia was defined as grade 3 or higher according to the Common
Terminology Criteria for Adverse Events version 4 (CTCAE v4.0) or
decreased oxygen saturation at rest (e.g., pulse oximeter <
88% or PaO2 ≤ 55 mmHg). Possible predictive factors on
admission were first screened for using univariate analyses with a P
value of 0.05, then models of the predictive power of the outcome were
evaluated by generating receiver operating characteristic (ROC) curves.
Results : Eleven patients (14.7%) had the outcome, including
three (4.0%) who required respiratory support in the intensive care
unit. The area under the curve of the ROC for the predictive factors
screened by univariate analyses were 0.84 (95% confidence interval
(CI): 0.73-0.95) for lactate
dehydrogenase (LDH) and 0.90 (95% CI: 0.82-0.98) for the disseminated
intravascular coagulation (DIC) score.