Yoneda Akihiro, Nishikawa Masanori, Uehara Shuichiro, Oue Takaharu, Usui Noriaki, Inoue Masami, Fukuzawa Masahiro, Okuyama Hiroomi
Department of Paediatric Surgery, Osaka City General Hospital, Osaka, Japan.
Department of Radiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
Eur J Pediatr Surg. 2016 Feb;26(1):117-22. doi: 10.1055/s-0035-1566100. Epub 2015 Nov 3.
Image-defined risk factors (IDRFs) have been propounded for predicting the surgical risks associated with localized neuroblastoma (NB) since 2009. In 2011, a new guideline (NG) for assessing IDRFs was published. According to the NG, the situation in which "the tumor is only in contact with renal vessels," should be considered to be "IDRF-present." Previously, this situation was diagnosed as "IDRF absent." In this study, we evaluated the IDRFs in localized NB patients to clarify the predictive capability of IDRFs for surgical complications, as well as the usefulness of the NG. Materials and
A total of 107 localized patients with NB were included in this study. The enhanced computed tomography and magnetic resonance images from the time of their diagnoses were evaluated by a single radiologist. We also analyzed the association of clinical factors, including the IDRFs (before and after applying the NG), with surgical complications.
Of the 107 patients, 33 and 74 patients were diagnosed as IDRF-present (OP group), and IDRF-absent (ON group) before the NG, respectively. According to the NG, there were 76 and 31 patients who were classified as IDRF-present (NP group) and IDRF absent (NN group), respectively. Thus, 43 (40%) patients in the ON group were reassigned to the NP group after the NG. Surgical complications were observed in 17 of 82 patients who underwent surgical resection. Of the patients who underwent secondary operations, surgical complication rates were 55% in the OP group and 44% in the NP group. According to a univariate analysis, non-INSS 1, IDRFs before and after the NG and secondary operations were significantly associated with surgical complications. In a multivariate analysis, non-INSS 1 status and IDRFs after the NG were significantly associated with surgical complications.
自2009年以来，已提出图像定义风险因素（IDRFs）用于预测与局限性神经母细胞瘤（NB）相关的手术风险。2011年，发布了一项评估IDRFs的新指南（NG）。根据该NG，“肿瘤仅与肾血管接触”的情况应被视为“存在IDRF”。此前，这种情况被诊断为“不存在IDRF”。在本研究中，我们评估了局限性NB患者的IDRFs，以阐明IDRFs对手术并发症的预测能力以及NG的实用性。
本研究共纳入107例局限性NB患者。由一名放射科医生评估其诊断时的增强计算机断层扫描和磁共振图像。我们还分析了包括IDRFs（应用NG前后）在内的临床因素与手术并发症的相关性。
在107例患者中，NG发布前分别有33例和74例患者被诊断为存在IDRF（OP组）和不存在IDRF（ON组）。根据NG，分别有76例和31例患者被分类为存在IDRF（NP组）和不存在IDRF（NN组）。因此，NG发布后，ON组中有43例（40%）患者被重新分配到NP组。在82例行手术切除的患者中，有17例出现手术并发症。在接受二次手术的患者中，OP组的手术并发症发生率为55%，NP组为44%。单因素分析显示，非国际神经母细胞瘤分期系统（INSS）1期、NG应用前后的IDRFs以及二次手术与手术并发症显著相关。多因素分析显示，非INSS 1期状态和NG应用后的IDRFs与手术并发症显著相关。
