Prognostic factors for survival in children with cancer and febrile neutropenia

Abstract

Cancer remains one of the most important diseases in public health. 

Objective: To estimate 5-year survival in pediatric cancer patients affected by FN, according to clinical-demographic variables. 

Patients and Method: Survival, prognostic, and analytical study with historical cohort. analytical. Cancer was grouped into leukemias-lymphomas, osteosarcoma, and other solid tumors. Descripti- ve analysis was performed with Fisher and Kruskal-Wallis tests; prognostic factors like age, type of cancer, and sepsis were analyzed with hazard ratio (HR). The Kaplan-Meier method and the Cox regression model were used for the survival curves. 

Results: We studied 116 subjects diagnosed with leukemia-lymphoma (51.7%), osteosarcoma (25.9%), and other solid tumors (22.4%). The median number of days between chemotherapy and the first episode of FN was 5 days [1-7], 7 [7-8], and 7 [5- 8], respectively. Overall survival was 64.7% at 5 years. Protective factors according to Cox Model were post-cancer comorbidity (HR 0.33 CI95% 0.16-0.67) and average educational level of the caregiver (HR 0.36 CI95% 0.18-0.73) and risk factors were the presence of another type of solid organ tumor (HR 3.43 CI95% 1.64-7.19), sepsis (HR 2.89 CI95% 1.47-5.70), delay in chemotherapy (HR 2.94 CI95% 1.17-7.40), and invasive fungal infection (HR 3.36 CI95% 1.22-9.22). 

Conclusion: Our study analyzed prognostic factors on survival in children with cancer and FN, finding risk and protective factors consistent with the literature. The presence of a solid organ tumor and sepsis were confirmed as risk factors, while the presence of post-cancer comorbidity and average educational level were protective factors in survival.