Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China.
Chin Med J (Engl). 2018 Oct 5;131(19):2332-2337. doi: 10.4103/0366-6999.241803.
This study was to review the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma (NB).
The online database ScienceDirect (201-2018) was utilized. The search was conducted using the keywords "neuroblastoma," "neuroblastoma resection," "neuroblastoma surgery," and "high-risk neuroblastoma."
We retrospectively analyzed of patients who underwent surgical resections in different clinical situations. The article included findings from selected relevant randomized controlled trials, systematic reviews, and meta-analyses or good-quality observational studies. Abstracts only, letters, and editorial notes were excluded. Full-text articles and abstracts were extracted and reviewed to identify key articles discussing surgery management of NB, which were then selected for critical analysis.
A total of 7800 English language articles were found containing references to NB (201-2018). The 163 articles were searched which were related to the surgical treatment of NB (201-2018). Through the analysis of these important articles, we found that the treatments of NB at low- and intermediate-risk groups were basically the same. High-risk patients remained controversial.
NB prognosis varies tremendously based on the stage and biologic features of the tumor. After reviewing the relevant literature, patients with low-risk disease are often managed with surgical resection or observation alone with tumors likely to spontaneously regress that are not causing symptoms. Intermediate patients are treated with chemotherapy with the number of cycles depending on their response as well as surgical resection of the primary tumor. High-risk patients remain controversial. Multidisciplinary intensive treatment is essential, especially for patients who received subtotal tumor resection. Minimally invasive surgery for the treatment of NBs without image-defined risk factors in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome. We conclude that ≥90% resection of the primary tumor is both feasible and safe in most patients with high-risk NB. New targeted therapies are crucial to improve survival.
本研究旨在回顾不同临床情况下手术切除的疗效，以便更好地理解手术在神经母细胞瘤（NB）治疗中的意义。
利用在线数据库 ScienceDirect（201-2018 年）。使用关键词“神经母细胞瘤”、“神经母细胞瘤切除术”、“神经母细胞瘤手术”和“高危神经母细胞瘤”进行搜索。
我们回顾性分析了在不同临床情况下接受手术切除的患者。文章包括从选定的相关随机对照试验、系统评价和荟萃分析或高质量观察性研究中获得的发现。仅摘录摘要、信件和社论注释被排除。提取并审查全文文章和摘要，以确定讨论 NB 手术管理的关键文章，然后选择这些文章进行批判性分析。
共发现 7800 篇含有 NB（201-2018 年）参考文献的英文文章。共搜索到 163 篇与 NB 手术治疗相关的文章（201-2018 年）。通过对这些重要文章的分析，我们发现低危和中危组的 NB 治疗基本相同。高危患者仍存在争议。
NB 的预后因肿瘤的分期和生物学特征而有很大差异。在回顾相关文献后，低危疾病患者通常仅接受手术切除或观察治疗，肿瘤可能自行消退，且不会引起症状。中危患者接受化疗，化疗周期取决于其反应以及原发肿瘤的手术切除情况。高危患者仍存在争议。多学科强化治疗至关重要，特别是对于接受部分肿瘤切除术的患者。对于低危至高危患者，无影像定义风险因素的 NB 采用微创治疗是安全可行的，不会影响治疗效果。我们的结论是，大多数高危 NB 患者可行且安全地实现原发肿瘤≥90%切除。新的靶向治疗对于提高生存率至关重要。
