Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis
Although intensive multimodal treatment has improved the prognosis of patients with metastatic neuroblastoma, the impact of primary tumor resection on outcome is a matter of medical debate. Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older...
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| Veröffentlicht in: | Journal of clinical oncology 2013-02, Vol.31 (6), p.752-758 |
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| creator | Simon, Thorsten Häberle, Beate Hero, Barbara von Schweinitz, Dietrich Berthold, Frank |
| description | Although intensive multimodal treatment has improved the prognosis of patients with metastatic neuroblastoma, the impact of primary tumor resection on outcome is a matter of medical debate.
Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older at diagnosis were included. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome.
A total of 278 patients were included in this study. Image-defined risk factors present at diagnosis were found to be predictive for the extent of tumor resection at first (P < .001) and best (P < .001) operation. No patient died from surgery. Before chemotherapy, complete resection, incomplete resection, and biopsy or no surgery were performed in 6.1%, 5.0%, and 88.5% of patients, respectively. The extent of first operation had no impact on event-free survival (EFS; P = .207), local progression-free survival (LPFS; P = .195), and overall survival (OS; P = .351). After induction chemotherapy, 54.7% of patients underwent complete resection of the primary tumor, 30.6% underwent incomplete resection, and 13.3% had only biopsy or no surgery of the primary tumor. The extent of best operation also had no impact on EFS (P = .877), LPFS (P = .299), and OS (P = .778). Moreover, multivariate analyses showed that surgery did not affect EFS, LPFS, and OS.
In intensively treated patients with stage 4 neuroblastoma age 18 months or older at diagnosis, surgery of the primary tumor site has no impact on local control rate and outcome. |
| doi_str_mv | 10.1200/JCO.2012.45.9339 |
| format | Article |
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Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older at diagnosis were included. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome.
A total of 278 patients were included in this study. Image-defined risk factors present at diagnosis were found to be predictive for the extent of tumor resection at first (P < .001) and best (P < .001) operation. No patient died from surgery. Before chemotherapy, complete resection, incomplete resection, and biopsy or no surgery were performed in 6.1%, 5.0%, and 88.5% of patients, respectively. The extent of first operation had no impact on event-free survival (EFS; P = .207), local progression-free survival (LPFS; P = .195), and overall survival (OS; P = .351). After induction chemotherapy, 54.7% of patients underwent complete resection of the primary tumor, 30.6% underwent incomplete resection, and 13.3% had only biopsy or no surgery of the primary tumor. The extent of best operation also had no impact on EFS (P = .877), LPFS (P = .299), and OS (P = .778). Moreover, multivariate analyses showed that surgery did not affect EFS, LPFS, and OS.
In intensively treated patients with stage 4 neuroblastoma age 18 months or older at diagnosis, surgery of the primary tumor site has no impact on local control rate and outcome.</description><identifier>ISSN: 0732-183X</identifier><identifier>EISSN: 1527-7755</identifier><identifier>DOI: 10.1200/JCO.2012.45.9339</identifier><identifier>PMID: 23284039</identifier><language>eng</language><publisher>Alexandria, VA: American Society of Clinical Oncology</publisher><subject>Adolescent ; Biological and medical sciences ; Child ; Child, Preschool ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Infant ; Maintenance Chemotherapy - methods ; Male ; Medical sciences ; Multivariate Analysis ; Neoplasm Staging ; Neuroblastoma - pathology ; Neuroblastoma - surgery ; Neuroblastoma - therapy ; Neurology ; Outcome Assessment (Health Care) - methods ; Outcome Assessment (Health Care) - statistics & numerical data ; Prognosis ; Proportional Hazards Models ; Radiotherapy - methods ; Randomized Controlled Trials as Topic ; Stem Cell Transplantation - methods ; Tumors ; Tumors of the nervous system. Phacomatoses ; Young Adult</subject><ispartof>Journal of clinical oncology, 2013-02, Vol.31 (6), p.752-758</ispartof><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-c22ba5986b0c6c894c4bd9b34eb7768d5f7cd039863799f7b01036fcf26f55b03</citedby><cites>FETCH-LOGICAL-c401t-c22ba5986b0c6c894c4bd9b34eb7768d5f7cd039863799f7b01036fcf26f55b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,3730,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27042005$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23284039$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Simon, Thorsten</creatorcontrib><creatorcontrib>Häberle, Beate</creatorcontrib><creatorcontrib>Hero, Barbara</creatorcontrib><creatorcontrib>von Schweinitz, Dietrich</creatorcontrib><creatorcontrib>Berthold, Frank</creatorcontrib><title>Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>Although intensive multimodal treatment has improved the prognosis of patients with metastatic neuroblastoma, the impact of primary tumor resection on outcome is a matter of medical debate.
Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older at diagnosis were included. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome.
A total of 278 patients were included in this study. Image-defined risk factors present at diagnosis were found to be predictive for the extent of tumor resection at first (P < .001) and best (P < .001) operation. No patient died from surgery. Before chemotherapy, complete resection, incomplete resection, and biopsy or no surgery were performed in 6.1%, 5.0%, and 88.5% of patients, respectively. The extent of first operation had no impact on event-free survival (EFS; P = .207), local progression-free survival (LPFS; P = .195), and overall survival (OS; P = .351). After induction chemotherapy, 54.7% of patients underwent complete resection of the primary tumor, 30.6% underwent incomplete resection, and 13.3% had only biopsy or no surgery of the primary tumor. The extent of best operation also had no impact on EFS (P = .877), LPFS (P = .299), and OS (P = .778). Moreover, multivariate analyses showed that surgery did not affect EFS, LPFS, and OS.
In intensively treated patients with stage 4 neuroblastoma age 18 months or older at diagnosis, surgery of the primary tumor site has no impact on local control rate and outcome.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Combined Modality Therapy</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Maintenance Chemotherapy - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging</subject><subject>Neuroblastoma - pathology</subject><subject>Neuroblastoma - surgery</subject><subject>Neuroblastoma - therapy</subject><subject>Neurology</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Outcome Assessment (Health Care) - statistics & numerical data</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Radiotherapy - methods</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Stem Cell Transplantation - methods</subject><subject>Tumors</subject><subject>Tumors of the nervous system. Phacomatoses</subject><subject>Young Adult</subject><issn>0732-183X</issn><issn>1527-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1v1DAQhi0EotvCnRPyBYlLFn_G9rFaPkpVuhUtgpvlOM7GxYmL7Qj13-NVt_Q0o5lnXo0eAN5gtMYEoQ_nm-2aIEzWjK8VpeoZWGFORCME58_BCglKGizpryNwnPMtQphJyl-CI0KJZIiqFfj9PQYH4wCvl7Rz6R76GZbRwZvkTJncXPa7K1N8bTP86csIr4vZOcjgpVtS7ILJJU4GntYZlvBbnMuYYUxwG3qXoCnwoze7OWafX4EXgwnZvT7UE_Dj86ebzVlzsf3ydXN60ViGcGksIZ3hSrYdsq2VilnW9aqjzHVCtLLng7B9fV62VCg1iA5hRNvBDqQdOO8QPQHvH3LvUvyzuFz05LN1IZjZxSVrTKRUilSDFUUPqE0x5-QGfZf8ZNK9xkjvFeuqWO8Va8b1XnE9eXtIX7rJ9f8PHp1W4N0BMNmaMCQzW5-fOIFYDeZP3Oh341-fnM6TCaHGEn1rI8W61YIT-g90NY9S</recordid><startdate>20130220</startdate><enddate>20130220</enddate><creator>Simon, Thorsten</creator><creator>Häberle, Beate</creator><creator>Hero, Barbara</creator><creator>von Schweinitz, Dietrich</creator><creator>Berthold, Frank</creator><general>American Society of Clinical Oncology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130220</creationdate><title>Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis</title><author>Simon, Thorsten ; Häberle, Beate ; Hero, Barbara ; von Schweinitz, Dietrich ; Berthold, Frank</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-c22ba5986b0c6c894c4bd9b34eb7768d5f7cd039863799f7b01036fcf26f55b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Combined Modality Therapy</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Maintenance Chemotherapy - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging</topic><topic>Neuroblastoma - pathology</topic><topic>Neuroblastoma - surgery</topic><topic>Neuroblastoma - therapy</topic><topic>Neurology</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Outcome Assessment (Health Care) - statistics & numerical data</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Radiotherapy - methods</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Stem Cell Transplantation - methods</topic><topic>Tumors</topic><topic>Tumors of the nervous system. Phacomatoses</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Simon, Thorsten</creatorcontrib><creatorcontrib>Häberle, Beate</creatorcontrib><creatorcontrib>Hero, Barbara</creatorcontrib><creatorcontrib>von Schweinitz, Dietrich</creatorcontrib><creatorcontrib>Berthold, Frank</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Simon, Thorsten</au><au>Häberle, Beate</au><au>Hero, Barbara</au><au>von Schweinitz, Dietrich</au><au>Berthold, Frank</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis</atitle><jtitle>Journal of clinical oncology</jtitle><addtitle>J Clin Oncol</addtitle><date>2013-02-20</date><risdate>2013</risdate><volume>31</volume><issue>6</issue><spage>752</spage><epage>758</epage><pages>752-758</pages><issn>0732-183X</issn><eissn>1527-7755</eissn><abstract>Although intensive multimodal treatment has improved the prognosis of patients with metastatic neuroblastoma, the impact of primary tumor resection on outcome is a matter of medical debate.
Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older at diagnosis were included. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome.
A total of 278 patients were included in this study. Image-defined risk factors present at diagnosis were found to be predictive for the extent of tumor resection at first (P < .001) and best (P < .001) operation. No patient died from surgery. Before chemotherapy, complete resection, incomplete resection, and biopsy or no surgery were performed in 6.1%, 5.0%, and 88.5% of patients, respectively. The extent of first operation had no impact on event-free survival (EFS; P = .207), local progression-free survival (LPFS; P = .195), and overall survival (OS; P = .351). After induction chemotherapy, 54.7% of patients underwent complete resection of the primary tumor, 30.6% underwent incomplete resection, and 13.3% had only biopsy or no surgery of the primary tumor. The extent of best operation also had no impact on EFS (P = .877), LPFS (P = .299), and OS (P = .778). Moreover, multivariate analyses showed that surgery did not affect EFS, LPFS, and OS.
In intensively treated patients with stage 4 neuroblastoma age 18 months or older at diagnosis, surgery of the primary tumor site has no impact on local control rate and outcome.</abstract><cop>Alexandria, VA</cop><pub>American Society of Clinical Oncology</pub><pmid>23284039</pmid><doi>10.1200/JCO.2012.45.9339</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Society of Clinical Oncology Online Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adolescent Biological and medical sciences Child Child, Preschool Combined Modality Therapy Disease-Free Survival Female Humans Infant Maintenance Chemotherapy - methods Male Medical sciences Multivariate Analysis Neoplasm Staging Neuroblastoma - pathology Neuroblastoma - surgery Neuroblastoma - therapy Neurology Outcome Assessment (Health Care) - methods Outcome Assessment (Health Care) - statistics & numerical data Prognosis Proportional Hazards Models Radiotherapy - methods Randomized Controlled Trials as Topic Stem Cell Transplantation - methods Tumors Tumors of the nervous system. Phacomatoses Young Adult |
| title | Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis |
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