Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pediatr Blood Cancer. 2024 Oct;71(10):e31161. doi: 10.1002/pbc.31161. Epub 2024 Jul 10.
The capacity of presurgical image-defined risk factors (IDRFs) to predict secondary surgical outcomes in patients with neuroblastoma is controversial.
The International Neuroblastoma Surgical Report Form (INSRF) was employed to retrospectively collect the clinical data of 53 patients diagnosed with neuroblastoma at our hospital from April 2014 to April 2020. IDRFs were identified at the time of diagnosis and reassessed during the course of neoadjuvant chemotherapy. Various statistical tests were used to evaluate the correlation between IDRFs and secondary surgical outcomes.
A total of 195 IDRFs were identified. Notably, by two courses of neoadjuvant chemotherapy, the number of "two body compartments," "intraspinal tumor extension," and "trachea-compressing" IDRFs decreased significantly (p = .001). The primary tumor volumes and the number of IDRFs decreased significantly by four courses of neoadjuvant chemotherapy, especially in "intraspinal tumor extension" IDRFs (p = .034). The median number of IDRF per patient was four (interquartile range [IQR]: 1-5) at diagnosis, which diminished to one (IQR: 1-3) subsequent to neoadjuvant chemotherapy. The presence of preoperative IDRFs was not associated with surgical complications (p = .286) or the extent of surgery (p = .188). However, the number of preoperative IDRFs linked to the extent of surgery (p = .002), not to operative complications (p = .669). Specifically, presurgery "renal vessel contact" IDRFs were predictive of surgical complications, while presurgery "infiltration of vital structures" IDRFs were associated with the extent of surgery.
The number of IDRFs decreased significantly by four courses of neoadjuvant chemotherapy. The number and type of presurgery IDRFs may predict secondary surgical outcomes, surpassing the mere consideration of their presence or absence.
术前影像学定义的风险因素（IDRFs）预测神经母细胞瘤患者二次手术结果的能力存在争议。
采用国际神经母细胞瘤外科报告表（INSRF）回顾性收集 2014 年 4 月至 2020 年 4 月我院收治的 53 例神经母细胞瘤患者的临床资料。在诊断时确定 IDRFs，并在新辅助化疗过程中重新评估。采用各种统计检验评估 IDRFs 与二次手术结果的相关性。
共确定了 195 个 IDRFs。值得注意的是，经过两个疗程的新辅助化疗，“两个体腔”、“椎管内肿瘤延伸”和“气管压迫”IDRFs 的数量明显减少（p=0.001）。四个疗程的新辅助化疗后，原发肿瘤体积和 IDRFs 的数量明显减少，尤其是“椎管内肿瘤延伸”IDRFs（p=0.034）。患者诊断时的 IDRF 中位数为 4 个（四分位距 [IQR]：1-5），新辅助化疗后减至 1 个（IQR：1-3）。术前 IDRFs 的存在与手术并发症（p=0.286）或手术范围无关（p=0.188）。然而，术前 IDRFs 的数量与手术范围有关（p=0.002），与手术并发症无关（p=0.669）。具体而言，术前“肾血管接触”IDRFs 与手术并发症相关，而术前“浸润重要结构”IDRFs 与手术范围相关。
经过四个疗程的新辅助化疗，IDRFs 的数量明显减少。术前 IDRFs 的数量和类型可能预测二次手术结果，超过了单纯考虑其存在与否。
