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The impact of early resection of primary neuroblastoma on the survival of children older than 1 year of age with stage 4 disease
The St. Jude Children's Research Hospital experience
Version of Record online: 15 NOV 2005
Copyright © 2005 American Cancer Society
Volume 104, Issue 12, pages 2837–2846, 15 December 2005
How to Cite
McGregor, L. M., Rao, B. N., Davidoff, A. M., Billups, C. A., Hongeng, S., Santana, V. M., Hill, D. A., Fuller, C. and Furman, W. L. (2005), The impact of early resection of primary neuroblastoma on the survival of children older than 1 year of age with stage 4 disease. Cancer, 104: 2837–2846. doi: 10.1002/cncr.21566
- Issue online: 8 DEC 2005
- Version of Record online: 15 NOV 2005
- Manuscript Accepted: 27 JUL 2005
- Manuscript Revised: 26 JUL 2005
- Manuscript Received: 9 MAR 2005
- Childhood Cancer Solid Tumor Program Project. Grant Number: CA-23099
- Cancer Center Support (CORE)
- National Cancer Institute. Grant Number: CA-21765
- American Lebanese Syrian Associated Charities (ALSAC)
- surgical procedures;
- disease-free survival;
- postoperative complications
It remains unclear whether primary tumor resection benefits patients with metastatic neuroblastoma. The authors assessed the impact of extent and timing of resection on outcome in these patients.
The authors reviewed the records of 124 patients > 1 year of age at diagnosis of International Neuroblastoma Staging System Stage 4 neuroblastoma. The survival estimates of those who did and did not have a gross total resection (GTR) and of those who had initial versus delayed GTR were compared. Surgical complications were reviewed.
The 5-year survival estimates were comparable for the 90 patients who had a GTR and the 17 who underwent surgery but did not have a GTR (29.9% ± 5.1% [standard error] vs. 29.4% ± 10.1%). The 7 patients who underwent GTR at the time of diagnosis had a higher 5-year survival estimate than the 83 patients who had a GTR after induction chemotherapy (83.3% ± 13.9% vs. 25.2% ± 5.0%) (P = 0.001). Five-year event-free survival estimates were similarly higher in the initial-GTR group (57.1% ± 18.7% vs. 14.5% ± 4.2%) (P = 0.002). These two groups did not differ significantly in age at diagnosis (P = 0.118), site of primary tumor (P = 0.34), MYCN amplification status (P = 1), serum lactate dehydrogenase activity at diagnosis (P = 0.34), or treatment protocol (P = 0.22). Twenty-two (21%) patients had a surgical complication.
In this small cohort of patients with metastatic neuroblastoma, GTR at the time of diagnosis offered a survival benefit. Further prospective studies are warranted before this approach can be applied to all patients with metastatic neuroblastoma. Cancer 2005. © 2005 American Cancer Society.