Impact of Extent of Surgical Resection on Survival in Patients With High-risk Neuroblastoma

IF 7.4 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2026-10-07 DOI:10.1097/sla.0000000000007228

Christa N. Grant,Arlene Naranjo,Fan F. Zhang,Lisa R. Diller,Erin G. Brown,James D. Geiger,John J. Doski,Daphne A. Haas-Kogan,Jed G. Nuchtern,Andrew M. Davidoff,Julie Park,Steven G. DuBois,Rochelle Bagatell,Dave R. Lal,Erika A. Newman

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引用次数: 0

Abstract

Objective: The impact of extent of resection of the primary tumor on outcomes in patients with high-risk neuroblastoma (HRNB) remains uncertain. We evaluated this issue in patients with HRNB treated on a prospective trial of multimodality therapy. Summary of Background Data: Patients with HRNB enrolled on COG ANBL0532 who underwent surgical resection of their primary tumor during induction were included. Extent of resection was defined by the surgeon as complete excision (CE) if ≥90% of the tumor was resected, and incomplete excision (IE) if <90% was resected. Methods: Overall and event-free survival (OS, EFS) were estimated from time of surgery and compared between groups with a log-rank test. Cumulative incidence of local progression (CILP) was estimated using competing risks analysis and compared between groups with Gray test. Results: A total of 326 patients met inclusion criteria (CE=269, IE=57). Demographics were comparable between groups. CE was more likely in patients with adrenal tumors, MYCN -amplified tumors, and those without image-defined risk factors ( P <0.05). Patients with CE had improved 5-year EFS (50.3%±3.3% vs. 31.0%±6.4%; P =0.0016) and OS (61.8%±3.1% vs. 41.1%±6.9%; P =0.0094) and decreased 5-year CILP (12.8%±2.1% vs. 24.8%±5.8%; P =0.0306). When stratified by extent of resection and autologous stem-cell transplant type, patients with CE randomized to tandem transplant had the highest 5-year EFS, while patients with IE and single transplant had inferior outcomes (57.9±5.5% vs. 18.5±11.8%; P =0.0411). Among patients who received immunotherapy CE was associated with improved 5-year EFS. There was no difference in surgical complications between IE and CE. Conclusions: CE of the primary tumor was associated with significantly higher EFS, OS, and decreased CILP, with no increase in surgical complications. As part of a comprehensive, multimodal treatment strategy, complete primary tumor resection when feasible is a critical component of therapy.

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手术切除程度对高危神经母细胞瘤患者生存的影响

目的：原发肿瘤切除程度对高危神经母细胞瘤（HRNB）患者预后的影响尚不确定。我们在多模式治疗的前瞻性试验中评估了HRNB患者的这一问题。背景资料总结：入选COG ANBL0532的HRNB患者在诱导过程中接受了原发肿瘤的手术切除。切除的范围由外科医生定义为完全切除（CE），如果≥90%的肿瘤被切除，不完全切除（IE），如果90%的肿瘤被切除。方法：从手术时间开始估计总生存期和无事件生存期（OS， EFS），并通过log-rank检验比较两组之间的差异。使用竞争风险分析估计累积局部进展发生率（CILP），并使用Gray检验进行组间比较。结果：326例患者符合纳入标准（CE=269， IE=57）。组间人口统计数据具有可比性。肾上腺肿瘤、MYCN扩增肿瘤和无影像学危险因素的患者发生CE的可能性更高（P <0.05）。CE患者5年EFS（50.3%±3.3% vs. 31.0%±6.4%;P =0.0016）和OS（61.8%±3.1% vs. 41.1%±6.9%;P =0.0094）改善，5年CILP（12.8%±2.1% vs. 24.8%±5.8%;P =0.0306）降低。当按切除程度和自体干细胞移植类型分层时，随机分配到串联移植的CE患者的5年EFS最高，而IE和单一移植患者的5年预后较差（57.9±5.5% vs. 18.5±11.8%;P =0.0411）。在接受免疫治疗的患者中，CE与改善的5年EFS相关。IE和CE的手术并发症无差异。结论：原发肿瘤的CE与较高的EFS、OS和较低的CILP相关，且未增加手术并发症。作为综合、多模式治疗策略的一部分，在可行的情况下完全切除原发肿瘤是治疗的关键组成部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.