Complete surgical resection improves outcome in INRG high-risk patients with localized neuroblastoma older than 18 months

BMC Cancer

Research Article

Ruth Volland¹  Barbara Hero¹  Janina Fischer¹  Frank Berthold¹  Thorsten Simon¹  Alexandra Pohl²  Dietrich von Schweinitz²  Martin Dübbers³  Grigore Cernaianu³ 

[1] Department of Pediatric Oncology and Hematology, University Children’s Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany;Department of Pediatric Surgery, Dr. von Haunersches Children‘s Hospital, Munich, Germany;Division of Pediatric Surgery, University Children‘s Hospital of Cologne, Cologne, Germany;

关键词: Surgical oncology;    High-risk neuroblastoma;    Localized neuroblastoma;    Neuroblastoma surgery;   

DOI  :  10.1186/s12885-017-3493-0

 received in 2017-05-15, accepted in 2017-07-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAlthough several studies have been conducted on the role of surgery in localized neuroblastoma, the impact of surgical timing and extent of primary tumor resection on outcome in high-risk patients remains controversial.MethodsPatients from the German neuroblastoma trial NB97 with localized neuroblastoma INSS stage 1–3 age > 18 months were included for retrospective analysis. Imaging reports were reviewed by two independent physicians for Image Defined Risk Factors (IDRF). Operation notes and corresponding imaging reports were analyzed for surgical radicality. The extent of tumor resection was classified as complete resection (95–100%), gross total resection (90–95%), incomplete resection (50–90%), and biopsy (<50%) and correlated with local control rate and outcome. Patients were stratified according to the International Neuroblastoma Risk Group (INRG) staging system. Survival curves were estimated according to the method of Kaplan and Meier and compared by the log-rank test.ResultsA total of 179 patients were included in this study. 77 patients underwent more than one primary tumor operation. After best surgery, 68.7% of patients achieved complete resection of the primary tumor, 16.8% gross total resection, 14.0% incomplete surgery, and 0.5% biopsy only. The cumulative complication rate was 20.3% and the surgery associated mortality rate was 1.1%. Image defined risk factors (IDRF) predicted the extent of resection. Patients with complete resection had a better local-progression-free survival (LPFS), event-free survival (EFS) and OS (overall survival) than the other groups. Subgroup analyses showed better EFS, LPFS and OS for patients with complete resection in INRG high-risk patients. Multivariable analyses revealed resection (complete vs. other), and MYCN (non-amplified vs. amplified) as independent prognostic factors for EFS, LPFS and OS.ConclusionsIn patients with localized neuroblastoma age 18 months or older, especially in INRG high-risk patients harboring MYCN amplification, extended surgery of the primary tumor site improved local control rate and survival with an acceptable risk of complications.

【 授权许可】

CC BY   
© The Author(s). 2017