Poster Presentation Advances in Neuroblastoma Research Congress 2016

Role of Surgery in Patients older than 18 months with localized Neuroblastoma (Stage 1-3) (#213)

Janina Fischer 1 , Alexandra Pohl 2 , Ruth Volland 1 , Barbara Hero 1 , Grigore Cernaianu 3 , Martin Dübbers 3 , Frank Berthold 1 , Diettrich von Schweinitz 2 , Thorsten Simon 1
  1. Pediatric Oncology, University Hospital of Cologne, Cologne, Germany
  2. Pediatric Surgery, Dr. von Haunersches Kinderspital, University Hospital of Munich, Munich, Germany
  3. Pediatric Surgery, University Hospital of Cologne, Cologne, Germany

Purpose

Although several studies have been conducted on the role of surgery in localized neuroblastoma the impact of surgical timing and extent of primary tumor resection on outcome remains controversial.

Patients and Methods

Patients from the German clinical trial NB97 with localized neuroblastoma INSS stage 1-3 age >18 months were included for retrospective analysis. Imaging reports were reviewed by two independent physicians for Image Defined Risk Factors (IDRF) and operation notes and corresponding imaging reports were analyzed for surgical radicality. The extent of tumor resection was classified as complete resection (95-100%), gross total resection (90-95%), incomplete resection (50-90%), and biopsy (<50%) and correlated with local control rate and outcome.

Results

A total of 181 patients were included in this study At diagnosis, 45.1% of all patients had complete resection, 12.5% gross total resection, 4.3% incomplete resection, and 36.4% biopsy only. Complication rate was 16.9%. Image defined risk factors (IDRF) predicted extent of resection.

76 patients underwent more than one primary tumor resection. At best surgery, 70.2% of patients achieved complete resection of the primary tumor, 15.5% gross total resection, 13.8% incomplete surgery, and 0.05% biopsy only. Cumulative complication rate was 20.1% and surgery associated mortality rate was 0.8%. Patients with complete resection had a better local-progression-free survival (LPFS), event-free survival (EFS) and OS than the other groups. Subgroup analyses showed better EFS for patients with complete resection in INSS stage 3 disease and in localized neuroblastoma with MYCN amplification. Multivariable analyses revealed resection (complete vs. other), and MYCN (non-amplified vs. amplified) as independent prognostic factors for EFS and OS .

Conclusion

In patients with localized neuroblastoma age 18 months or older, especially in patients with MYCN amplification, extended surgery of the primary tumor site improves local control rate and survival with an acceptable risk of complications.