Department of Pediatric and Adolescent Oncology, Gustave Roussy, Paris-Saclay University, Paris, France.
Department of Pediatric and Adolescent Oncology, Gustave Roussy, Paris-Saclay University, Paris, France.
Eur J Cancer. 2021 Feb;144:1-8. doi: 10.1016/j.ejca.2020.10.020. Epub 2020 Dec 11.
There is rising concern on the impact of new strategies, such as high-dose chemotherapy (HDC) and immunotherapy, on the pattern of relapse in high-risk neuroblastoma (HR-NBL). Our aim is to evaluate the incidence and identify risk factors for first recurrence in the central nervous system (CNS) in HR-NBL.
Data from patients with stage 4V HR-NBL included from February 2002 to June 2015 in the prospective HR-NBL trial of the European International Society of Pediatric Oncology Neuroblastoma Group were analysed. Characteristics at diagnosis, treatment and the pattern of first relapse were studied. CNS imaging at relapse was centrally reviewed.
The 1977 included patients had a median age of 3 years (1 day-20 years); 1163 were boys. Among the 1161 first relapses, 53 were in the CNS, with an overall incidence of 2.7%, representing 6.2% of all metastatic relapses. One- and three-year post-relapse overall survival was 25 ± 6% and 8 ± 4%, respectively. Higher risk of CNS recurrence was associated with female sex (hazard ratio [HR] = 2.0 [95% confidence interval {CI}: 1.1-3.5]; P = 0.016), MYCN-amplification (HR = 2.4 [95% CI: 1.2-4.4]; P = 0.008), liver (HR = 2.5 [95% CI: 1.2-5.1]; P = 0.01) or >1 metastatic compartment involvement (HR = 7.1 [95% CI: 1.0-48.4]; P = 0.047) at diagnosis. Neither HDC nor immunotherapy was associated with higher risk of CNS recurrence. Stable incidence of CNS relapse was reported over time.
The risk of CNS recurrence is linked to both patient and disease characteristics, with neither impact of HDC nor immunotherapy. These findings support the current treatment strategy and do not justify a CNS prophylactic treatment.
人们越来越关注新策略（如大剂量化疗[HDC]和免疫疗法）对高危神经母细胞瘤[HR-NBL]复发模式的影响。我们的目的是评估 HR-NBL 中中枢神经系统（CNS）首次复发的发生率并确定其危险因素。
对 2002 年 2 月至 2015 年 6 月期间欧洲国际儿科肿瘤学会神经母细胞瘤组前瞻性 HR-NBL 试验中纳入的 4V 期 HR-NBL 患者的数据进行了分析。研究了诊断时的特征、治疗方法和首次复发模式。对复发时的 CNS 影像学进行了中心审查。
共纳入 1977 例患者，中位年龄为 3 岁（1 天-20 岁）；1163 例为男性。在 1161 例首次复发中，53 例为 CNS 复发，总发生率为 2.7%，占所有转移性复发的 6.2%。复发后 1 年和 3 年的总生存率分别为 25±6%和 8±4%。CNS 复发的风险较高与女性（危险比[HR]为 2.0[95%置信区间{CI}：1.1-3.5]；P=0.016）、MYCN 扩增（HR 为 2.4[95%CI：1.2-4.4]；P=0.008）、肝（HR 为 2.5[95%CI：1.2-5.1]；P=0.01）或>1 个转移部位受累（HR 为 7.1[95%CI：1.0-48.4]；P=0.047）有关。HDC 和免疫疗法均与 CNS 复发风险增加无关。随着时间的推移，CNS 复发的发生率保持稳定。
CNS 复发的风险与患者和疾病特征有关，HDC 和免疫疗法均无影响。这些发现支持目前的治疗策略，并且不支持 CNS 预防性治疗。
