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Tumor resection of at least 90% improves EFS in pediatric neuroblastoma
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Tumor resection of 90% or greater significantly improved EFS and lowered cumulative incidence of local progression, according to data from an analysis of the Children’s Oncology Group A3973 Study.
“The role of primary tumor resection, including regional lymphadenectomy, in patients with high-risk neuroblastoma remains controversial,” Daniel von Allmen, MD, of the Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “The uncertainty results from a lack of randomized trials assessing the impact of surgical variables. Indeed, the effect of primary tumor resection has not been included as a specific aim in any reported cooperative group studies until a recent analysis by the International Society of Pediatric Oncology Europe–Neuroblastoma.”
Researchers identified 220 children from the Children’s Oncology Group A3983 study who had both resection of the primary tumor site and central surgery review, dividing patients into two categories of resection: less than 90% (n = 66) and 90% or greater (n = 154). Von Allmen and colleagues obtained resection data on tumor resection from operating surgeons’ assessments. Researchers used blinded central imaging reviews of tomography scans for 84 patients. Primary outcomes were OS, EFS and cumulative incidence of local progression (CILP).
Five-year OS was 54.9%, five-year CILP was 11.9% and five-year EFS was 43.5%, von Allmen and colleagues reported. Resection of 90% or greater was associated with better EFS (HR = 1.4; 95% CI, 0.9-2) than resection less than 90%, and a lower CILP (HR = 2.6; 95% CI, 1.2-5.5).
Multivariable analysis showed that after adjustment for MYCN amplification or diploidy, resection of 90% or greater was associated with longer EFS but not OS (HR = 1.2; 95% CI, 0.8-1.9), von Allmen and colleagues wrote.
Agreement between surgeons’ assessments of resection and central image-guided review was 63%.
“In summary, our analysis demonstrates that [resection of 90% or greater] of the primary tumor in the treatment of high-risk neuroblastoma has a positive effect on outcomes in a representative cohort from the COG A3973 trial. These data include a strong association between more complete resection and better local control; indeed, resection of 90% or greater was the only independent predictor of reduced cumulative incidence of local progression in multivariate analysis,” the researchers wrote. “In addition, the complication rate was not increased in patients who underwent more extensive surgery. Our findings support continued attempts at [resection of 90% or greater] resection of the primary tumor in this cohort. The role of unbiased review of postsurgical imaging in predicting patient outcome warrants further investigation.” – by Andy Polhamus
Disclosure: von Allmen reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
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