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Influence of Surgical Excision on the Survival of Patients With Stage 4 High-Risk Neuroblastoma: A Report From the HR-NBL1/SIOPEN Study
K. Holmes, U. Pötschger, ADJ. Pearson, S. Sarnacki, G. Cecchetto, J. Gomez-Chacon, R. Squire, E. Freud, A. Bysiek, LE. Matthyssens, M. Metzelder, T. Monclair, J. Stenman, M. Rygl, L. Rasmussen, JM. Joseph, S. Irtan, S. Avanzini, J. Godzinski, K....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem
Grantová podpora
8177
Cancer Research UK - United Kingdom
NLK
Free Medical Journals
od 2004 do Před 1 rokem
Open Access Digital Library
od 1999-01-01
PubMed
32639845
DOI
10.1200/jco.19.03117
Knihovny.cz E-zdroje
- MeSH
- cytoredukční chirurgie škodlivé účinky metody statistika a číselné údaje MeSH
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- multicentrické studie jako téma MeSH
- neuroblastom mortalita patologie chirurgie terapie MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- přežití bez známek nemoci MeSH
- proporcionální rizikové modely MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití MeSH
- randomizované kontrolované studie jako téma MeSH
- staging nádorů MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE: To evaluate the impact of surgeon-assessed extent of primary tumor resection on local progression and survival in patients in the International Society of Pediatric Oncology Europe Neuroblastoma Group High-Risk Neuroblastoma 1 trial. PATIENTS AND METHODS: Patients recruited between 2002 and 2015 with stage 4 disease > 1 year or stage 4/4S with MYCN amplification < 1 year who had completed induction without progression, achieved response criteria for high-dose therapy (HDT), and had no resection before induction were included. Data were collected on the extent of primary tumor excision, severe operative complications, and outcome. RESULTS: A total of 1,531 patients were included (median observation time, 6.1 years). Surgeon-assessed extent of resection included complete macroscopic excision (CME) in 1,172 patients (77%) and incomplete macroscopic resection (IME) in 359 (23%). Surgical mortality was 7 (0.46%) of 1,531. Severe operative complications occurred in 142 patients (9.7%), and nephrectomy was performed in 124 (8.8%). Five-year event-free survival (EFS) ± SE (0.40 ± 0.01) and overall survival (OS; 0.45 ± 0.02) were significantly higher with CME compared with IME (5-year EFS, 0.33 ± 0.03; 5-year OS, 0.37 ± 0.03; P < .001 and P = .004). The cumulative incidence of local progression (CILP) was significantly lower after CME (0.17 ± 0.01) compared with IME (0.30 ± 0.02; P < .001). With immunotherapy, outcomes were still superior with CME versus IME (5-year EFS, 0.47 ± 0.02 v 0.39 ± 0.04; P = .038); CILP was 0.14 ± 0.01 after CME and 0.27 ± 0.03 after IME (P < .002). A hazard ratio of 1.3 for EFS associated with IME compared with CME was observed before and after the introduction of immunotherapy (P = .030 and P = .038). CONCLUSION: In patients with stage 4 high-risk neuroblastoma who have responded to induction therapy, CME of the primary tumor is associated with improved survival and local control after HDT, local radiotherapy (21 Gy), and immunotherapy.
Agia Sofia Children's Hospital Athens Greece
Department of Pediatric Surgery University Children's Hospital Kraków Poland
Department of Surgical Gastroenterology A Odense University Hospital Odense Denmark
Institut Gustave Roussy Villejuif Paris France
Institute of Cancer Research and Royal Marsden Hospital Sutton United Kingdom
Jagiellonian University Medical College Kraków Poland
Karolinska University Hospital Stockholm Sweden
Oslo University Hospital Rikshospitalet Oslo Norway
Paediatric Haematology Oncology Our Lady's Children's Hospital Crumlin Dublin Republic of Ireland
Paediatric Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
Paediatric Oncology Great Ormond Street Hospital London United Kingdom
Paediatric Oncology Leeds Teaching Hospital Leeds United Kingdom
Paediatric Oncology Paediatric Surgical Oncology Unit Hospital Universitario La FE Valencia Spain
Paediatric Surgery Medical University of Vienna Vienna Austria
Paediatric Surgery St George's Hospital London and Royal Marsden Hospital Sutton United Kingdom
Pediatric Surgery Department of Women's and Children's Health University of Padua Padua Italy
Pediatric Surgery Unit IRCCS Istituto Giannina Gaslini Genoa Italy
Portuguese Institute of Oncology Lisbon Portugal
Sackler School of Medicine Tel Aviv University Tel Aviv Israel
Schneider Children's Medical Center of Israel Petach Tikvah Israel
Sydney Children's Hospital Randwick New South Wales Australia
University College Hospital London United Kingdom
University Hospital Lausanne Lausanne Switzerland
University Hospital Motol Prague Czech Republic
Citace poskytuje Crossref.org
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