OBJECTIVE: To summarize the experience in the treatment of stage IV neuroblastoma admitted in recent years and to explore appropriate treatment options. METHODS: To retrospectively summarize the data of patients with stage IV neuroblastoma admitted from April 2008 to March 2010 and compare the results of different ages, primary tumor sites, metastatic sites, pathological staging, and serum NSE levels. All patients were followed up for up to 2 years. RESULTS: From April 2008 to March 2010, 6 patients with stage IV neuroblastoma were admitted, 3 males and 3 females, aged 1 month to 3 years old; the first symptoms were soft tissue masses on the body in 4 cases and abdominal masses in 2 cases; the primary tumor sites were retroperitoneal adrenal glands in 3 cases and mediastinum in 3 cases; the primary tumor sizes were 5-10 cm in diameter; the metastatic sites included: skin soft tissue in 3 cases, bone marrow in 5 cases, liver in 2 cases, and bone metastases in 3 cases. The primary tumor size was 5-10 CM; metastatic sites included: skin and soft tissue in 3 cases, bone marrow in 5 cases, liver in 2 cases, bone metastasis in 3 cases, and lymph nodes in 4 cases; serum NSE level was 19-36 ng/L. All pathologies were diagnosed by biopsy. Except for one case in which a tumor was first found in the back and tumor resection was performed, the pathological diagnosis was neuroblastoma, and then a retroperitoneal tumor was found after systemic examination, and then retroperitoneal tumor resection was performed with postoperative adjuvant chemotherapy; in the other five cases, after biopsy or bone marrow pathological diagnosis, chemotherapy was first performed, and after 3-5 courses of chemotherapy, one of the primary mediastinal tumors shrank significantly and was surgically resected; in the other three cases, the tumor disappeared on imaging and the serum NSE level decreased to normal. In the other three cases, the tumor disappeared on imaging, the serum NSE level decreased to normal, and no abnormal area was seen on PET/CT examination, so no surgery was performed and the follow-up was continued. one 3-year-old child had a negative bone marrow after 5 times of chemotherapy, and the serum NSE decreased to normal level, but the mediastinal tumor decreased, but the degree of reduction was less than 20%. Discussion: Neuroblastoma is one of the most common malignant tumors in pediatric patients. Depending on the age, tumor location, pathological type, and biological genetic characteristics of the children, the clinical manifestations are very complex and varied, and the prognosis varies greatly. All of the patients in this group belonged to clinicopathological stage IV, and three of them had their tumors completely disappeared after neoadjuvant chemotherapy. It is suggested that the treatment of low age stage IV neuroblastoma with active chemotherapy can achieve very good therapeutic effect.