Departments of Surgery and Urology, IWK Health Centre, Dalhousie University, Halifax, Canada.
Department of Surgery, Children's Hospital at London Health Sciences Centre, Western University, London, Canada.
Pediatr Blood Cancer. 2023 Jun;70(6):e30286. doi: 10.1002/pbc.30286. Epub 2023 Mar 28.
To determine whether extent of surgical resection of the primary tumor correlates with survival in patients with International Neuroblastoma Staging System (INSS) stage 4, high-risk neuroblastoma.
Data were extracted for patients with newly diagnosed INSS stage 4, high-risk neuroblastoma between 2001 and 2019 from the national Cancer in Young People in Canada (CYPC) database. Complete resection was defined as gross total resection of primary tumor based on operative reports. Primary endpoints were 3 and 5-year event-free (EFS) and overall survival (OS). Survival analyses were completed using log-rank test and Cox proportional hazards regression including covariates of age, sex, decade of treatment (2001-2009 vs. 2010-2019), immunotherapy, and tandem stem cell transplant (SCT).
One-hundred and forty patients with complete surgical data were included. On univariate analysis, 3-year EFS and OS for patients that had complete versus incomplete resection was 71% (95% CI 57-80%) vs. 48% (36-60%) and 86% (75-93%) vs. 64% (51-74%), p = .008 and p = .002, respectively. 5-year EFS and OS for patients with complete resection also demonstrated significantly improved survival. On Cox Proportional Hazards models adjusted for age, immunotherapy, tandem SCT, and surgical resection, only complete resection was associated with statistically significant improved 3 year EFS and OS, HR = 0.48 (0.29-0.81; p = .006) and HR = 0.42 (0.24-0.73; p = .002).
In a large Canadian INSS stage 4 high-risk neuroblastoma cohort, complete surgical resection was associated with increased EFS and OS. Within the constraints of a retrospective study, these results suggest that the ability to achieve primary tumor complete resection in patients with metastatic high-risk disease is associated with improved survival.
确定原发性肿瘤切除范围与国际神经母细胞瘤分期系统（INSS）分期 4 期、高危神经母细胞瘤患者的生存情况是否相关。
从加拿大青年癌症（CYPC）数据库中提取 2001 年至 2019 年间新诊断为 INSS 分期 4 期、高危神经母细胞瘤的患者数据。完全切除定义为根据手术报告进行的大体全切除。主要终点是 3 年和 5 年无事件生存率（EFS）和总生存率（OS）。使用对数秩检验和 Cox 比例风险回归进行生存分析，包括年龄、性别、治疗十年（2001-2009 年与 2010-2019 年）、免疫治疗和串联干细胞移植（SCT）的协变量。
共纳入 140 例有完整手术资料的患者。单因素分析显示，完全切除与不完全切除患者的 3 年 EFS 和 OS 分别为 71%（95%CI 57-80%）与 48%（36-60%）和 86%（75-93%）与 64%（51-74%），p=0.008 和 p=0.002。完全切除患者的 5 年 EFS 和 OS 也显示出明显的生存改善。在调整年龄、免疫治疗、串联 SCT 和手术切除的 Cox 比例风险模型中，只有完全切除与统计学显著改善的 3 年 EFS 和 OS 相关，HR=0.48（0.29-0.81；p=0.006）和 HR=0.42（0.24-0.73；p=0.002）。
在加拿大 INSS 分期 4 期高危神经母细胞瘤大队列中，完全手术切除与 EFS 和 OS 增加相关。在回顾性研究的限制内，这些结果表明，在转移性高危疾病患者中实现原发性肿瘤完全切除的能力与改善生存相关。
