Abstract
Introduction Image-defined risk factors (IDRFs) have been propounded for predicting the surgical
risks associated with localized neuroblastoma (NB) since 2009. In 2011, a new guideline
(NG) for assessing IDRFs was published. According to the NG, the situation in which
“the tumor is only in contact with renal vessels,” should be considered to be “IDRF-present.”
Previously, this situation was diagnosed as “IDRF absent.” In this study, we evaluated
the IDRFs in localized NB patients to clarify the predictive capability of IDRFs for
surgical complications, as well as the usefulness of the NG.
Materials and Methods A total of 107 localized patients with NB were included in this study. The enhanced
computed tomography and magnetic resonance images from the time of their diagnoses
were evaluated by a single radiologist. We also analyzed the association of clinical
factors, including the IDRFs (before and after applying the NG), with surgical complications.
Results Of the 107 patients, 33 and 74 patients were diagnosed as IDRF-present (OP group),
and IDRF-absent (ON group) before the NG, respectively. According to the NG, there
were 76 and 31 patients who were classified as IDRF-present (NP group) and IDRF absent
(NN group), respectively. Thus, 43 (40%) patients in the ON group were reassigned
to the NP group after the NG. Surgical complications were observed in 17 of 82 patients
who underwent surgical resection. Of the patients who underwent secondary operations,
surgical complication rates were 55% in the OP group and 44% in the NP group. According
to a univariate analysis, non-INSS 1, IDRFs before and after the NG and secondary
operations were significantly associated with surgical complications. In a multivariate
analysis, non-INSS 1 status and IDRFs after the NG were significantly associated with
surgical complications.
Keywords
neuroblastoma - image-defined risk factor - surgical complication - new guideline
