Klin Padiatr 2016; 228(03): 118-123
DOI: 10.1055/s-0041-111175
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Image-defined Risk Factors Correlate with Surgical Radicality and Local Recurrence in Patients with Neuroblastoma

Image-defined Risk Factors korrelieren mit chirurgischer Radikalität und Lokalrezidiven bei Neuroblastom-Patienten
A. Pohl
1   Department of Pediatric Surgery, Dr. von Hauners’ childrens hospital, Munich, Germany
,
M. Erichsen
1   Department of Pediatric Surgery, Dr. von Hauners’ childrens hospital, Munich, Germany
,
M. Stehr
2   Department of Pediatric Surgery, Cnopf’sche Children’s Clinic, Nuremberg, Germany
,
J. Hubertus
1   Department of Pediatric Surgery, Dr. von Hauners’ childrens hospital, Munich, Germany
,
F. Bergmann
1   Department of Pediatric Surgery, Dr. von Hauners’ childrens hospital, Munich, Germany
,
B. Kammer
3   Institute for Clinical Radiology, Dr. von Haunersches Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
,
D. von Schweinitz
1   Department of Pediatric Surgery, Dr. von Hauners’ childrens hospital, Munich, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
29 February 2016 (online)

Abstract

Background: Neuroblastoma is the second most common solid pediatric tumor and the most common cancer to be detected in children younger than 12 months of age. To date, 2 different staging systems describe the extent of the disease: the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Risk Group Staging System (INRGSS). The INRGSS-system is characterized by the presence or absence of so called image-defined risk factors (IDRFs), which are described as surgical risk factors. We hypothesized that IDRFs correlate with surgical complications, surgical radicality, local recurrence and overall survival (OS).

Patients and methods: Between 2003 and 2010, 102 patients had neuroblastoma surgery performed in our department. We analyzed medical records for IDRF-status and above named data.

Results: 16 patients were IDRF-negative, whereas 86 patients showed one or more IDRF. Intra- or postoperative complications have been reported in 21 patients (21%). 19 of them showed one or more IDRF and 2 patients were IDRF-negative (p=n.s.). Patients who suffered from intra- or postoperative complications demonstrated a decreased OS (p=0.011). Statistical analysis revealed an inverse correlation between the extent of macroscopical removal and IDRF-status (p=0.001). Furthermore, the number of IDRFs were associated with a decreased likelihood of radical tumor resection (p<0.001). 19 patients had local recurrence; all of them were IDRF-positive (p=0.037).

Conclusions: Pediatric surgeons should consider IDRFs as a useful tool for risk assessment and therefore planning for neuroblastoma surgery.

Zusammenfassung

Hintergrund: Das Neuroblastom ist der zweithäufigste solide Tumor im Kindesalter und die häufigste Krebsart bei Kindern jünger als 12 Monate. Aktuell beschreiben 2 Staging-Einteilungen das Ausmass der Erkrankung: das International Neuroblastoma Staging System (INSS) und das International Neuroblastoma Risk Group Staging System (INRGSS). Das INRGSS-System ist charakterisiert durch die Präsenz bzw. Abwesenheit von sogenannten image-defined risk factors (IDRFs), welche als chirurgische Risikofaktoren beschrieben sind. Ziel dieser Arbeit ist es, die Bedeutung von IDRFs im Hinblick auf Komplikationen, chirurgische Radikalität, Lokalrezidiven sowie Overall Survival (OS) zu evaluieren.

Patienten und Methoden: Zwischen 2003 und 2010 wurden 102 Patienten in unserer Klinik an einem Neuroblastom operiert. Die Akten wurden retrospektiv nach o.g. Faktoren ausgewertet.

Resultate: 16 Patienten waren IDRF-negativ; 86 Patienten zeigten einen oder mehrere IDRF. Intra- oder postoperative Komplikationen wurden bei 21 Patienten beobachtet. Hiervon zeigten 19 Patienten IDRF und 2 Patienten zeigten keinen IDRF. Patienten, welche unter intra- und/oder postoperativen Komplikationen litten, zeigten ein verkürztes OS (p=0.011). Die statistische Analyse zeigte eine inverse Korrelation zwischen dem Ausmass der makroskopischen Tumor-Entfernung sowie dem IDRF-Status (p=0.001). Zusätzlich zeigte sich ein signifikanter Zusammenhang zwischen der Anzahl der IDRF sowie der durchgeführten Radikalität der Tumorresektion (p<0.001). 19 Patienten entwickelten im Verlauf ein Lokalrezidiv, diese zeigten alle einen oder mehrere IDRF (p=0.037).

Schlussfolgerung: Kinderchirurgen sollten IDRF als ein sinnvolles Werkzeug für die Risikostratifizierung und Planung der Neuroblastom-Chirurgie nutzen.

 
  • References

  • 1 Becker K, Furch C, Schmid I et al. Impact of postoperative complications on overall survival of patients with hepatoblastoma. Pediatric blood & cancer 2015; 62: 24-28
  • 2 Bessho F, Hashizume K, Nakajo T et al. Mass screening in Japan increased the detection of infants with neuroblastoma without a decrease in cases in older children. The Journal of pediatrics 1991; 119: 237-241
  • 3 Berthold F, Sahin K, Hero B et al. The current contribution of molecular factors to risk estimation in neuroblastoma patients. Eur J Cancer 1997; 33: 2092-2097
  • 4 Bown N. Neuroblastoma tumour genetics: clinical and biologicalaspects. Journal of clinical pathology 2001; 54: 897-910
  • 5 Bowman LC, Grossmann M, Rill D et al. Interleukin-2 gene-modified allogeneic tumor cells for treatment of relapsed neuroblastoma. Human gene therapy 1998; 9: 1303-1311
  • 6 Brodeur GM, Seeger RC, Barrett A et al. International criteria for diagnosis, staging, and response to treatment in patients with neuroblastoma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1988; 6: 1874-1881
  • 7 Brodeur GM, Pritchard J, Berthold F et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1993; 11: 1466-1477
  • 8 Castel V, Tovar JA, Costa E et al. The role of surgery in stage IV neuroblastoma. Journal of pediatric surgery 2002; 37: 1574-1578
  • 9 Cecchetto G, Mosseri V, De Bernardi B et al. Surgical risk factors in primary surgery for localized neuroblastoma: the LNESG1 study of the European International Society of Pediatric Oncology Neuroblastoma Group. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2005; 23: 8483-8489
  • 10 Cohn SL, Pearson AD, London WB et al. The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2009; 27: 289-297
  • 11 Gantt Jr. GA, Ashburn J, Kiran RP et al. Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer. Surgical endoscopy. 2014
  • 12 Gunther P, Troger J, Holland-Cunz S et al. Surgical complications in abdominal tumor surgery in children. Experiences at a single oncological center. European journal of pediatric surgery: official journal of Austrian Association of Pediatric Surgery [et al.]=Zeitschrift fur Kinderchirurgie 2009; 19: 297-303
  • 13 Hsu WM, Jen YM, Lee H et al. The influence of biologic factors on the surgical decision in advanced neuroblastoma. Annals of surgical oncology 2006; 13: 238-244
  • 14 Irtan S, Brisse HJ, Minard-Colin V et al. Minimally invasive surgery of neuroblastic tumors in children: Indications depend on anatomical location and image-defined risk factors. Pediatric blood & cancer. 2014
  • 15 Koh CC, Sheu JC, Liang DC et al. Complete surgical resection plus chemotherapy prolongs survival in children with stage 4 neuroblastoma. Pediatric surgery international 2005; 21: 69-72
  • 16 La Quaglia MP, Kushner BH, Su W et al. The impact of gross total resection on local control and survival in high-risk neuroblastoma. Journal of pediatric surgery 2004; 39: 412-417
  • 17 Matthay KK, Perez C, Seeger RC et al. Successful treatment of stage III neuroblastoma based on prospective biologic staging: a Children’s Cancer Group study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1998; 16: 1256-1264
  • 18 Matthay KK, George RE, Yu AL.. Promising therapeutic targets in neuroblastoma. Clinical cancer research: an official journal of the American Association for Cancer Research 2012; 18: 2740-2753
  • 19 Merkow RP, Bilimoria KY, Tomlinson JS et al. Postoperative Complications Reduce Adjuvant Chemotherapy Use in Resectable Pancreatic Cancer. Annals of surgery 2013;
  • 20 Monclair T, Brodeur GM, Ambros PF et al. The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2009; 27: 298-303
  • 21 Morgenstern DA, Baruchel S, Irwin MS. Current and future strategies for relapsed neuroblastoma: challenges on the road to precision therapy. Journal of pediatric hematology/oncology 2013; 35: 337-347
  • 22 Simon T, Hero B, Benz-Bohm G et al. Review of image defined risk factors in localized neuroblastoma patients: Results of the GPOH NB97 trial. Pediatric blood & cancer 2008; 50: 965-969
  • 23 Simon T, Haberle B, Hero B et al. Role of surgery in the treatment of patients with stage 4 neuroblastoma age 18 months or older at diagnosis. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2013; 31: 752-758
  • 24 Tevis SE, Kohlnhofer BM, Stringfield S et al. Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Diseases of the colon and rectum 2013; 56: 1339-1348
  • 25 von Allmen D, Grupp S et al. Aggressive surgical therapy and radiotherapy for patients with high-risk neuroblastoma treated with rapid sequence tandem transplant. Journal of pediatric surgery 2005; 40: 936-941 discussion 41
  • 26 von Schweinitz D, Hero B, Berthold F. The impact of surgical radicality on outcome in childhood neuroblastoma. European journal of pediatric surgery: official journal of Austrian Association of Pediatric Surgery [et al.]=Zeitschrift fur Kinderchirurgie 2002; 12: 402-409