Hannah M Phelps1, Josephine M Ndolo2, Kyle J Van Arendonk3, Heidi Chen4, Hannah L Dietrich5, Katherine D Watson6, Melissa A Hilmes2, Dai H Chung3, Harold N Lovvorn7. 1. School of Medicine, Vanderbilt University Medical Center, Nashville, TN; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN. Electronic address: hannah.m.phelps@vanderbilt.edu. 2. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN. 3. Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN. 4. Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. 5. School of Nursing, Vanderbilt University Medical Center, Nashville, TN. 6. Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN. 7. Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN.
Abstract
BACKGROUND: The current neuroblastoma (NBL) staging system employs image-defined risk factors (IDRFs) to assess numerous anatomic features, but the impact of IDRFs on surgical and oncologic outcomes is unclear. METHODS: The Vanderbilt Cancer Registry identified children treated for NBL from 2002 to 2017. Tumor volume (TV) and IDRFs were measured radiographically at diagnosis and before resection. Perioperative and oncologic outcomes were evaluated. RESULTS: At diagnosis of 106 NBL, 61% were IDRF positive. MYCN-amplified and undifferentiated NBL had more IDRFs than nonamplified and more differentiated tumors (p = 0.001 and p = 0.01). Of 86 NBLs resected, 43% were IDRF positive, which associated with higher stage, risk, and TV (each p < 0.001). The presence of IDRF at resection was also associated with increased blood loss (p < 0.001), longer operating times (p < 0.001), greater incidence of intraoperative complications (p = 0.03), more frequent ICU admissions postoperatively (p < 0.001), and longer hospital stays (p < 0.001). IDRF negative and positive tumors did not have significantly different rates of gross total resection (p = 0.2). Five-year relapse-free and overall survival was similar for IDRF negative and positive NBL (p = 0.9 and p = 0.8). CONCLUSIONS: IDRFs at diagnosis were associated with larger, less differentiated, advanced stage, and higher risk NBL and at resection with increased operative difficulty and perioperative morbidity. However, the frequency of gross total resection and patient survival after resection were not associated with the presence of IDRFs. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The current neuroblastoma (NBL) staging system employs image-defined risk factors (IDRFs) to assess numerous anatomic features, but the impact of IDRFs on surgical and oncologic outcomes is unclear. METHODS: The Vanderbilt Cancer Registry identified children treated for NBL from 2002 to 2017. Tumor volume (TV) and IDRFs were measured radiographically at diagnosis and before resection. Perioperative and oncologic outcomes were evaluated. RESULTS: At diagnosis of 106 NBL, 61% were IDRF positive. MYCN-amplified and undifferentiated NBL had more IDRFs than nonamplified and more differentiated tumors (p = 0.001 and p = 0.01). Of 86 NBLs resected, 43% were IDRF positive, which associated with higher stage, risk, and TV (each p < 0.001). The presence of IDRF at resection was also associated with increased blood loss (p < 0.001), longer operating times (p < 0.001), greater incidence of intraoperative complications (p = 0.03), more frequent ICU admissions postoperatively (p < 0.001), and longer hospital stays (p < 0.001). IDRF negative and positive tumors did not have significantly different rates of gross total resection (p = 0.2). Five-year relapse-free and overall survival was similar for IDRF negative and positive NBL (p = 0.9 and p = 0.8). CONCLUSIONS: IDRFs at diagnosis were associated with larger, less differentiated, advanced stage, and higher risk NBL and at resection with increased operative difficulty and perioperative morbidity. However, the frequency of gross total resection and patient survival after resection were not associated with the presence of IDRFs. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.
Authors: Stephanie Young; R Luke Rettig; Ian V Hutchinson; Michael G Sutcliffe; Roman M Sydorak Journal: Pediatr Surg Int Date: 2022-07-07 Impact factor: 2.003
Authors: William C Temple; Kieuhoa T Vo; Katherine K Matthay; Brunilda Balliu; Christina Coleman; Jennifer Michlitsch; Andrew Phelps; Spencer Behr; Matthew A Zapala Journal: Cancer Med Date: 2020-12-13 Impact factor: 4.452