Value of surgical resection in children with high-risk neuroblastoma

BackgroundThe value of gross total resection (GTR) for children with high-risk neuroblastoma (NB) is controversial. We hypothesized that patients undergoing GTR would demonstrate improved overall survival (OS) compared those having <GTR. MethodsUsing a single institutional database, we reviewed the medical records of all children with high-risk NB undergoing hematopoietic stem cell transplantation (HSCT) as part of multimodality therapy from 1990 to 2012. Children had received surgical care at multiple institutions (n=14) prior to HSCT and were divided into two groups based on extent of surgical resection: GTR (no visible or palpable disease at end of operation) and <GTR (no surgery, biopsy only, or subtotal resection). Kaplan-Meier curves and Cox hazards models evaluated differences in overall survival (OS). ResultsOne hundred four children underwent HSCT, and 87 (83.6%) had adequate data for analysis. Thirty eight percent had GTR while 62% had <GTR prior to HSCT. There was no significant difference in OS in patients undergoing GTR compared to <GTR (Log rank test: P=0.49). Post-hoc analysis demonstrated a survival advantage for patients undergoing >90% resection compared to <90% resection (P=0.008). Multivariable Cox models confirmed these findings with improved survival in children undergoing >90% vs. <90% resection but no difference in GTR vs. <GTR. ConclusionGross total resection prior to HSCT in high-risk NB patients is not associated with improved OS compared to <GTR; however, these results suggest that >90% resection is associated with improved OS compared to less than 90% resection. Pediatr Blood Cancer 2015;62:1529-1535. (c) 2015 Wiley Periodicals, Inc.