Stokes Rachael, Bannon Aidan, Leung Bonnie, Alloo Jasmin, Davies-Payne David, Winstanley Mark, Wood Andrew, Evans Stephen, Hamill James
Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.
Department of Radiology, Starship Children's Hospital, Auckland, New Zealand.
ANZ J Surg. 2025 Jun;95(6):1147-1152. doi: 10.1111/ans.19420. Epub 2025 Jan 30.
Specific image defined risk factors (IDRF) immediately prior to surgery may be more relevant to paediatric oncology surgeons than pre-neoadjuvant IDRFs at diagnosis. The aim of this study was to determine IDRF subtypes that independently predict postoperative complications.
We searched the New Zealand Children's Cancer Registry for all cases of neuroblastoma treated at a single paediatric oncology centre between January 2007 and February 2021 and determined the IDRF status on pre-operative imaging at diagnosis and after neoadjuvant therapy. Surgical complications (Clavien-Dindo grade) were correlated with total number of IDRFs (pre- and post-chemotherapy) and three subsets: vascular encasement (VE), invasive (I), and extensive (E).
Of 101 patients, 73 underwent surgical resection, and 32 (44%) had a surgical complication. Of the 54 IDRF-positive tumours, all were treated by neoadjuvant therapy and in 17, all IDRFs resolved. Complications correlated with the number of post-neoadjuvant therapy VE-IDRFs at OR 1.2 (95% CI 1.0-1.4, P = 0.02) and extensive IDRFs at OR 1.7 (95% CI 1.1-1.9, P = 0.02). Pre-neoadjuvant IDRF status was not independently associated with complications when controlling for post-neoadjuvant IDRF status. The total number of VE-IDRF reduced from 181 pre-neoadjuvant therapy to 86 post, with tumour encasing the aorta and/or vena cava being the most common.
The vascular encasement and extensive subtypes of IDRF may be more useful prognostic indicators of surgical complications than the total number of IDRFs. This may have implications for reporting IDRF status on preoperative imaging and surgical planning but needs validation in larger cohort studies.
手术前即刻的特定影像定义风险因素（IDRF）可能比诊断时的新辅助治疗前IDRF对儿科肿瘤外科医生更具相关性。本研究的目的是确定能独立预测术后并发症的IDRF亚型。
我们在新西兰儿童癌症登记处搜索了2007年1月至2021年2月期间在单一儿科肿瘤中心接受治疗的所有神经母细胞瘤病例，并确定了诊断时和新辅助治疗后的术前影像上的IDRF状态。手术并发症（Clavien-Dindo分级）与IDRF总数（化疗前和化疗后）以及三个亚组相关：血管包绕（VE）、浸润性（I）和广泛性（E）。
101例患者中，73例接受了手术切除，32例（44%）出现手术并发症。在54例IDRF阳性肿瘤中，所有患者均接受了新辅助治疗，其中17例所有IDRF均消失。并发症与新辅助治疗后VE-IDRF数量相关，比值比为1.2（95%可信区间1.0-1.4，P = 0.02），与广泛性IDRF数量相关，比值比为1.7（95%可信区间1.1-1.9，P = 0.02）。在控制新辅助治疗后IDRF状态时，新辅助治疗前IDRF状态与并发症无独立相关性。VE-IDRF总数从新辅助治疗前的181个减少到新辅助治疗后的86个，肿瘤包绕主动脉和/或腔静脉最为常见。
IDRF的血管包绕和广泛性亚型可能比IDRF总数更有助于预测手术并发症。这可能对术前影像报告IDRF状态和手术规划有影响，但需要在更大的队列研究中进行验证。
