TY - JOUR
T1 - Influence of Surgical Excision on the Survival of Patients with Stage 4 High-Risk Neuroblastoma
T2 - A Report from the HR-NBL1/SIOPEN Study
AU - Holmes, Keith
AU - Pötschger, Ulrike
AU - Pearson, Andrew D.J.
AU - Sarnacki, Sabine
AU - Cecchetto, Giovanni
AU - Gomez-Chacon, Javier
AU - Squire, Roly
AU - Freud, Enrique
AU - Bysiek, Adam
AU - Matthyssens, Lucas E.
AU - Metzelder, Martin
AU - Monclair, Tom
AU - Stenman, Jakob
AU - Rygl, Michal
AU - Rasmussen, Lars
AU - Joseph, Jean Marc
AU - Irtan, Sabine
AU - Avanzini, Stefano
AU - Godzinski, Jan
AU - Björnland, Kristin
AU - Elliott, Martin
AU - Luksch, Roberto
AU - Castel, Victoria
AU - Ash, Shifra
AU - Balwierz, Walentyna
AU - Laureys, Geneviève
AU - Ruud, Ellen
AU - Papadakis, Vassilios
AU - Malis, Josef
AU - Owens, Cormac
AU - Schroeder, Henrik
AU - Beck-Popovic, Maja
AU - Trahair, Toby
AU - de Lacerda, Ana Forjaz
AU - Ambros, Peter F.
AU - Gaze, Mark N.
AU - McHugh, Kieran
AU - Valteau-Couanet, Dominique
AU - Ladenstein, Ruth Lydia
N1 - Publisher Copyright:
© 2020 by American Society of Clinical Oncology.
PY - 2020
Y1 - 2020
N2 - 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) 6 SE (0.40 6 0.01) and overall survival (OS; 0.45 6 0.02) were significantly higher with CME compared with IME (5-year EFS, 0.33 6 0.03; 5-year OS, 0.37 6 0.03; P, .001 and P 5 .004). The cumulative incidence of local progression (CILP) was significantly lower after CME (0.17 6 0.01) compared with IME (0.30 6 0.02; P, .001). With immunotherapy, outcomes were still superior with CME versus IME (5-year EFS, 0.47 6 0.02 v 0.39 6 0.04; P 5 .038); CILP was 0.14 6 0.01 after CME and 0.27 6 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 5 .030 and P 5 .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.
AB - 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) 6 SE (0.40 6 0.01) and overall survival (OS; 0.45 6 0.02) were significantly higher with CME compared with IME (5-year EFS, 0.33 6 0.03; 5-year OS, 0.37 6 0.03; P, .001 and P 5 .004). The cumulative incidence of local progression (CILP) was significantly lower after CME (0.17 6 0.01) compared with IME (0.30 6 0.02; P, .001). With immunotherapy, outcomes were still superior with CME versus IME (5-year EFS, 0.47 6 0.02 v 0.39 6 0.04; P 5 .038); CILP was 0.14 6 0.01 after CME and 0.27 6 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 5 .030 and P 5 .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.
UR - http://www.scopus.com/inward/record.url?scp=85090079587&partnerID=8YFLogxK
U2 - 10.1200/JCO.19.03117
DO - 10.1200/JCO.19.03117
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C2 - 32639845
AN - SCOPUS:85090079587
VL - 38
SP - 2902
EP - 2915
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 25
ER -
