Influence of Surgical Excision on the Survival of Patients With Stage 4 High-Risk Neuroblastoma: A Report From the HR-NBL1/SIOPEN Study.

Détails

ID Serval
serval:BIB_5AFE171DD336
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Influence of Surgical Excision on the Survival of Patients With Stage 4 High-Risk Neuroblastoma: A Report From the HR-NBL1/SIOPEN Study.
Périodique
Journal of clinical oncology
Auteur(s)
Holmes K., Pötschger U., Pearson ADJ, Sarnacki S., Cecchetto G., Gomez-Chacon J., Squire R., Freud E., Bysiek A., Matthyssens L.E., Metzelder M., Monclair T., Stenman J., Rygl M., Rasmussen L., Joseph J.M., Irtan S., Avanzini S., Godzinski J., Björnland K., Elliott M., Luksch R., Castel V., Ash S., Balwierz W., Laureys G., Ruud E., Papadakis V., Malis J., Owens C., Schroeder H., Beck-Popovic M., Trahair T., Forjaz de Lacerda A., Ambros P.F., Gaze M.N., McHugh K., Valteau-Couanet D., Ladenstein R.L.
Collaborateur(s)
International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOPEN)
ISSN
1527-7755 (Electronic)
ISSN-L
0732-183X
Statut éditorial
Publié
Date de publication
01/09/2020
Peer-reviewed
Oui
Volume
38
Numéro
25
Pages
2902-2915
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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 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.
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) ± SE (0.40 ± 0.01) and overall survival (OS; 0.45 ± 0.02) were significantly higher with CME compared with IME (5-year EFS, 0.33 ± 0.03; 5-year OS, 0.37 ± 0.03; P < .001 and P = .004). The cumulative incidence of local progression (CILP) was significantly lower after CME (0.17 ± 0.01) compared with IME (0.30 ± 0.02; P < .001). With immunotherapy, outcomes were still superior with CME versus IME (5-year EFS, 0.47 ± 0.02 v 0.39 ± 0.04; P = .038); CILP was 0.14 ± 0.01 after CME and 0.27 ± 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 = .030 and P = .038).
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.
Pubmed
Web of science
Création de la notice
13/07/2020 11:04
Dernière modification de la notice
14/10/2020 5:23
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