Neuroblastoma survival rate & prognosis — understanding your child's outlook

Neuroblastoma outcomes vary significantly by risk group. Children with low-risk neuroblastoma — tumours that are localised, have favourable biology, and no MYCN amplification — have excellent long-term outcomes, with most children achieving remission after surgery alone or surgery combined with chemotherapy. Intermediate-risk patients also do well with multi-agent chemotherapy. High-risk neuroblastoma, which accounts for roughly half of all cases at diagnosis, is more challenging; intensive multimodal treatment gives many children a meaningful chance at long-term remission, though outlook remains less predictable. The most meaningful prognosis discussion is the one your child's oncologist has with you based on your child's specific biological features.

The most important prognostic factors in neuroblastoma are the child's age at diagnosis (younger children, especially under 18 months, generally have more favourable outcomes), the stage of the disease (localised vs. metastatic), and the biology of the tumour cells. Tumour biology includes MYCN gene amplification (present in about 20–25% of cases and associated with more aggressive disease), histology (favourable vs. unfavourable Shimada classification), ploidy (diploid vs. hyperdiploid DNA content), and chromosomal abnormalities such as 1p deletion and 11q deletion. These biological features are assessed at diagnosis through tests including FISH, array CGH, and MIBG scanning, and they guide which risk group and treatment path your child follows.

Neuroblastoma is classified into low, intermediate, and high risk based on age, stage, and tumour biology. Low-risk: localised tumours with favourable biology in older infants and children — surgery alone is often enough, and outcomes are excellent. Intermediate-risk: tumours with some adverse features or regional spread — chemotherapy followed by surgery achieves remission in most children, with good long-term outcomes. High-risk: disease that has spread to distant lymph nodes or organs (Stage 4) or has MYCN amplification — this group requires intensive treatment including induction chemotherapy, surgery, high-dose consolidation with stem cell rescue, radiation, and immunotherapy. Each child's risk group is decided at diagnosis and reviewed as treatment progresses.

MYCN is a gene that, when amplified (present in extra copies) inside neuroblastoma cells, causes the tumour to grow faster and be less responsive to standard-intensity treatment. MYCN amplification is found in approximately 20–25% of neuroblastoma cases and is one of the strongest indicators that a child needs high-risk level treatment, regardless of other features. This is tested at diagnosis using a technique called fluorescence in situ hybridisation (FISH) on a sample of the tumour. Children whose tumours do not have MYCN amplification — even if the disease has spread — generally have more favourable tumour biology.

Yes, relapse is a recognised risk, particularly in high-risk neuroblastoma. Relapse most often occurs within the first two years after completing treatment, which is why follow-up scans and MIBG studies are scheduled regularly during and after therapy. If neuroblastoma does return, treatment options depend on how long after completing therapy the relapse occurs, what treatment was previously given, and where the disease has come back. Relapsed neuroblastoma is harder to treat than newly diagnosed disease, and many families at this stage seek a second-opinion tumour board review to ensure all options have been considered. Please bring your child back to your oncologist immediately if you notice new symptoms.

Yes. The MIBG (meta-iodobenzylguanidine) scan is the standard imaging tool for neuroblastoma because most neuroblastoma cells absorb MIBG. It is used at diagnosis to find out how many sites in the body are affected, and during and after treatment to assess how well the tumour is responding. A strongly MIBG-avid tumour at diagnosis that becomes MIBG-negative after induction chemotherapy is a good sign. The MIBG response score — a semi-quantitative count of disease sites — is one of the tools oncologists use to assess prognosis and decide whether treatment intensity should be escalated. CION's specialist team uses MIBG findings in combination with all other biological data in the tumour board discussion.