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Stage 4N neuroblastoma tumors may require less intensive therapy
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Patients with neuroblastoma who had metastatic disease limited to distant lymph nodes demonstrated improved outcomes and therefore may be eligible for less intensive therapy compared with other patients with stage IV disease, according to retrospective study results.
Researchers used the International Neuroblastoma Risk Group database to identify 2,250 patients diagnosed with stage IV disease from 1990 to 2002. Of the entire cohort, 146 (6.5%) had metastatic disease that was limited to the distant lymph nodes (4N disease).
Patients with 4N disease demonstrated significantly improved 5-year EFS (77% ± 4% vs. 35% ±1%) and 5-year OS (85% ± 3% vs. 42% ± 1%) compared with other patients with stage IV disease (both, P˂.001).
Researchers found patients with 4N disease were younger (P˂.001). These patients also demonstrated more favorable tumor characteristics, including less frequently amplified MYCN (P˂.001), favorable histologic category (P˂.001) and low mitosis karyorrhexis index (P=.0011).
Results of multivariate analyses indicated stage 4N disease significantly predicted OS (HR=3.69) and EFS (HR=3.40) compared with non-stage 4N disease. Stage 4N disease continued to predict improved outcomes in subgroup analyses stratified for age at diagnosis and tumor MYCN status.
“For those with 4N disease, outcome in terms of both EFS and OS is significantly better than for other stage 4 patients,” the researchers wrote. “Consideration should therefore be given to whether these 4N patients might be eligible for different classification in the current risk stratification system. In particular, they may not require further therapeutic escalation that is likely necessary to improve outcomes for the remaining high-risk stage 4 groups (those age ≥547 days or infants with metastatic [MYCN amplification] disease) and thus may reduce adverse late effects in these patients.”
Disclosure: The researchers report no relevant financial disclosures.
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