Association of Extent of Surgeon-Assessed Resection on Outcome in High-Risk Neuroblastoma
In an analysis of patients with high-risk neuroblastoma from the Children’s Oncology Group A3973 study reported in the Journal of Clinical Oncology, von Allmen et al found that surgeon-assessed resection of at least 90% was associated with improved event-free survival and a reduced cumulative incidence of local progression.
This study included 220 patients from the Children’s Oncology Group study who had both central surgery review and resection of the primary tumor site. Blinded central imaging review of computed tomography scans was performed in a subset of 84 patients.
Outcomes
Surgeon-assessed extent of resection was at least 90% in 154 patients (70%) and less than 90% in 66 patients (30%). Among all patients, 5-year event-free survival, overall survival, and cumulative incidence of local progression were 43.5%, 54.9%, and 11.9%, respectively.
In patients with surgeon-assessed extent of resection of at least 90% vs less than 90%, event-free survival was 45.9% vs 37.9% (hazard ratio [HR] = 1.4, P = .04); cumulative incidence of local progression was 8.5% vs 19.8% (HR = 2.6, P = .01); and overall survival was 57.3% vs 49.4% (HR = 1.2, P = .3).
On multivariable analysis adjusting for MYCN amplification or diploidy, less than 90% resection was associated with poorer event-free survival (HR = 1.6, P = .0205) and a higher cumulative incidence of local progression (HR = 3.1, P = .017), but no significant effect on overall survival was observed (HR = 1.4, P = .1211).
Low concordance was found between the extent of surgeon-assessed resection and central image-guided review in the 84 patients evaluated, with agreement in 63% of cases.
The investigators concluded: “Despite discordance between clinical assessment of resection extent and assessment via central imaging review, a surgeon-assessed resection extent ≥ 90% was associated with significantly better [event-free survival] and lower [cumulative incidence of local progression]. Improving overall survival, however, remains a challenge in this disease. These findings support continued attempts at ≥ 90% resection of the primary tumor in high-risk neuroblastoma.”
The study was supported by grants from the National Cancer Institute and the National Institutes of Health.
Michael P. La Quaglia, MD, of the Department of Surgery, Memorial Sloan Kettering Cancer Center, is the corresponding author of the Journal of Clinical Oncology article.
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