Qi Yingyi, Zhan Jianghua
Graduate College, Tianjin Medical University, Tianjin, China.
Department of General Surgery, Tianjin Children's Hospital, Tianjin, China.
Front Pediatr. 2021 Oct 13;9:706800. doi: 10.3389/fped.2021.706800. eCollection 2021.
Neuroblastoma is the most common extracranial solid tumor in children, and most patients are at high risk when they are initially diagnosed. The roles of surgery and induction chemotherapy in patients with high-risk neuroblastoma have been a subject of much controversy and debate. The objective of the current study was to assess the roles of surgery in high-risk neuroblastoma. The review protocol was prospectively registered (PROSPEROID: CRD42021253961). The PubMed, Embase, Cochrane, and CNKI databases were searched from inception to January 2020 with no restrictions on language or publication date. Clinical studies comparing the outcomes of different surgical ranges for the treatment of high-risk neuroblastoma were analyzed. The Mantel-Haenszel method and a random effects model was utilized to calculate the hazard ratio (95% CI). Fourteen studies that assessed 1,915 subjects met the full inclusion criteria. Compared with the gross tumor resection (GTR) group, complete tumor resection (CTR) did not significantly improve the 5-year EFS [ = 1.0; HR = 0.95 (95% CI, 0.87-1.05); = 0%], and the 5-year OS [ = 0.76; HR = 1.08 (95% CI, 0.80-1.46); = 0%] of patients. GTR or CTR resection had significantly better 5-year OS [p = 0.45; HR = 0.56 (95% CI, 0.43-0.72); = 0%] and 5-year EFS [ = 0.15; HR = 0.80 (95% CI, 0.71-0.90); = 31%] than subtotal tumor resection (STR) or biopsy only; however, both CTR or GTR showed a trend for more intra and post-operative complications compared with the STR or biopsy only [ = 0.37; OR = 1.54 (95% CI, 1.08-2.20); = 0%]. The EFS of the patients who underwent GTR or CTR at the time of diagnosis and after induction chemotherapy were similar [ = 0.24; HR = 1.53 (95% CI, 0.84-2.77); = 29%]. For patients with high-risk neuroblastoma, complete tumor resection and gross tumor resection of the primary tumor were related to improved survival, with very limited effects on reducing intraoperative and postoperative complications. It is necessary to design strong chemotherapy regimens to improve the survival rate of advanced patients. https://www.crd.york.ac.uk/PROSPERO/, PROSPEROID [CRD42021253961].
神经母细胞瘤是儿童最常见的颅外实体瘤，大多数患者在初诊时即处于高危状态。手术和诱导化疗在高危神经母细胞瘤患者中的作用一直是诸多争议和讨论的主题。本研究的目的是评估手术在高危神经母细胞瘤中的作用。本综述方案已进行前瞻性注册（PROSPERO ID：CRD42021253961）。检索了PubMed、Embase、Cochrane和中国知网数据库，检索时间从建库至2020年1月，对语言和出版日期无限制。分析了比较不同手术范围治疗高危神经母细胞瘤疗效的临床研究。采用Mantel-Haenszel法和随机效应模型计算风险比（95%CI）。14项评估1915名受试者的研究符合全部纳入标准。与肿瘤全切除（GTR）组相比，肿瘤完整切除（CTR）并未显著提高患者的5年无事件生存率[ = 1.0；HR = 0.95（95%CI，0.87 - 1.05）； = 0%]和5年总生存率[ = 0.76；HR = 1.08（95%CI，0.80 - 1.46）； = 0%]。GTR或CTR切除的患者5年总生存率[p = 0.45；HR = 0.56（95%CI，0.43 - 0.72）； = 0%]和5年无事件生存率[ = 0.15；HR = 0.80（95%CI，0.71 - 0.90）； = 31%]均显著优于肿瘤次全切除（STR）或仅行活检；然而，与仅行STR或活检相比，CTR或GTR均显示出术中及术后并发症更多的趋势[ = 0.37；OR = 1.54（95%CI，1.08 - 2.20）； = 0%]。诊断时及诱导化疗后接受GTR或CTR的患者的无事件生存率相似[ = 0.24；HR = 1.53（95%CI，0.84 - 2.77）； = 29%]。对于高危神经母细胞瘤患者，原发肿瘤的肿瘤完整切除和肿瘤全切除与生存率提高相关，但对减少术中和术后并发症的作用非常有限。有必要设计强效化疗方案以提高晚期患者的生存率。https://www.crd.york.ac.uk/PROSPERO/，PROSPERO ID [CRD42021253961]
