Lessons learned from different prognostic factors analysis in intermediate-risk neuroblastoma: ten years' experience at a tertiary center.

Abstract

Background: Intermediate-risk (IR) neuroblastoma represents a biologically and clinically diverse group of tumors. This study evaluates the feasibility of surgical excision and identifies prognostic factors that influence survival in IR-neuroblastoma patients, particularly those with suboptimal responses to induction chemotherapy.

Methods: We conducted a retrospective analysis of 50 pediatric patients diagnosed with IR-neuroblastoma at a tertiary cancer center between 2007 and 2016. Treatment responses, surgical outcomes, and survival data were assessed. Prognostic variables were evaluated using univariable and multivariable models.

Results: After four cycles of induction chemotherapy, 26% of patients showed an objective response, increasing to 62% by treatment completion. Surgical resection was performed in 70% of patients, with a higher proportion among non-responders. Initial response to induction chemotherapy was a significant independent predictor of surgical feasibility (p = 0.022) and final disease status (p = 0.026). Five-year overall survival (OS) was 84%, and event-free survival (EFS) was 72%. Surgical resection significantly improved end-of-treatment disease status in slow-responder patients but did not independently affect OS or EFS.

Conclusion: Moderate-intensity chemotherapy with or without surgery provides acceptable survival outcomes in IR-neuroblastoma. An early favorable response to induction therapy may justify avoiding surgery, while surgical resection remains critical for slow-responder patients.