Abstract

ABSTRACT Background and Objectives Neuroblastoma, the most common extracranial solid tumor in children, is rare in adults. This study compares patient characteristics, disease patterns, and treatments among adults, adolescents, and children with neuroblastoma. Methods We queried the National Cancer Database (2004–2019) for neuroblastoma cases. Patient and tumor characteristics, treatments, and 5‐year overall survival (5‐OS) were compared between adults (≥ 18 years), adolescents (10–17 years), and children (0–9 years). Kaplan–Meier curves and Cox regression assessed survival differences. Results Among 6350 neuroblastoma patients, 256 (4.0%) were adults, 222 (3.5%) were adolescents, and 5872 (92.5%) were children. Tumors were largest in adolescents (9.7 cm), followed by adults (8.0 cm) and children (6.7 cm) ( p < 0.001). Adults were less likely to have tumors in the adrenal glands (34.0% vs. children: 54.7%, adolescents: 43.2%, p < 0.001) and had lower rates of metastasis (10.9% vs. 19.3% and 19.4%, p < 0.001). Compared to children, adults received less chemotherapy, immunotherapy, and bone marrow transplants ( p < 0.001). 5‐OS was worse in adults (65.8%), followed by adolescents (70.4%) and children (78.2%) ( p < 0.001). After adjustment, adults (aHR: 2.27; 95% CI, 1.71–3.01) and adolescents (aHR: 2.02; 95% CI, 1.54–2.64) had higher hazards of death compared to children. Conclusions Adults and adolescents with neuroblastoma have distinct clinical features and lower survival than children, underscoring the need for tailored treatment approaches for older patients. Level of Evidence III.