PURPOSE: Neuroblastoma is the most common extracranial solid tumor of childhood, and its outcome in advanced diseases has been very poor. We evaluated the treatment outcome and prognostic factors in advanced neuroblastoma. METHODS: A retrospective review of 48 patients with neuroblastoma at Chonnam National University Hospital was undertaken. The conventional treatment was given to Stage 1, 2, 3 patients. For Stage 4 and relapsed patients, high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (PBSCT) was administered. All patients who completed the cytotoxic therapy then either received no further therapy or were treated with 13-cis-retinoic acid (CRA) for six months. RESULTS: Most of the patients were in advanced stages: 11 in stage III and 26 in stage IV. Autologous PBSCT was done in 14 cases. The 5-year event-free survival (EFS) was 41% in all patients with 100% for Stage 1, 67% for Stage 2/3, 35% for stage 4, 50% of 4S. In cases of stage 4 neuroblastoma, the EFS rate at 4 years after diagnosis was better in the autologous PBSCT group than in chemotherapy group (51% vs. 20%; P=.05). Also, the EFS was better in patients who received 13-CRA after PBSCT than those who did not (100% vs. 14%; P<.005). CONCLUSION: Treatment with high dose chemotherapy and autologous PBSCT improved the EFS among children with advanced neuroblastoma. In addition, treatment with 13-CRA was beneficial for patients who underwent transplantation. Prospective randomized study is warranted to further improve survival for the subset of advanced patients who might fail to current management strategies.