The optimal timing of surgical resection in high-risk neuroblastoma

Yesenia Rojas, Sergio Jaramillo, Karen Lyons, Nadia Mahmood, Meng Fen Wu, Hao Liu, Sanjeev A. Vasudevan, R. Paul Guillerman, Chrystal U. Louis, Heidi V. Russell, Jed G. Nuchtern, Eugene S. Kim

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background While most high-risk neuroblastoma (HRNB) patients are enrolled in cooperative group or institutional protocols, variability exists within these protocols as to when surgical resection of the primary tumor should be performed after neoadjuvant induction chemotherapy. We sought to determine if the number of chemotherapy cycles prior to surgery affects surgical or survival outcomes in HRNB patients. Methods We performed a retrospective review of all HRNB patients < 18 years of age from 2000 to 2010, at Texas Children's Hospital. Patients were stratified based on the number of neoadjuvant induction chemotherapy cycles prior to surgical resection. Pre and post- chemotherapy tumor size, MYCN status, iodine-131-metaiodobenzylguanidine (MIBG) score at diagnosis, extent of surgical resection, estimated surgical blood loss, post-operative outcomes, and event free (EFS) and overall survival (OS) were evaluated. Data were analyzed using Wilcoxon rank-sum test, Kruskal–Wallis test, Fisher's exact test, Kaplan–Meier analyses, and Cox regression analyses. P-value < 0.05 was considered significant. Results Data from 50 patients with HRNB were analyzed. Patients were stratified by the number of cycles of chemotherapy received prior to surgery. Six patients received 2 cycles of chemotherapy (12%), 20 patients received 3 cycles (40%), 13 patients received 4 cycles (26%), and 11 patients received 5 cycles (22%) prior to surgical resection of the primary tumor. The 5-year OS was 33%, 45%, 83% and 36% in patients who received 2, 3, 4 and 5 cycles of chemotherapy prior to surgery, respectively (p = 0.07). Multivariate analysis revealed that patients who received 4 cycles of chemotherapy had a significantly lower mortality (HR: 0.11, 95% CI: 0.01–0.87, p = 0.04) compared to those with 2 cycles of chemotherapy. Among the different cohorts, there were no differences with respect to MYCN status, MIBG score at diagnosis, incidence of bone marrow metastasis, extent of surgical resection, estimated blood loss, incidence of post-operative complications, or length of stay. Conclusion HRNB patients who receive 4 cycles of chemotherapy prior to surgical resection have a superior OS than patients who receive 2. Based on the superior survival of patients who received 4 cycles of chemotherapy prior to surgery, further studies are warranted to elucidate these differences.

Original languageEnglish (US)
Pages (from-to)1665-1669
Number of pages5
JournalJournal of Pediatric Surgery
Volume51
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

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Neuroblastoma
Drug Therapy
Survival
Induction Chemotherapy
Nonparametric Statistics
Surgical Blood Loss
Neoplasms
Incidence
Iodine
Length of Stay
Multivariate Analysis
Bone Marrow

Keywords

  • High-risk neuroblastoma
  • Induction chemotherapy
  • Surgical resection

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Rojas, Y., Jaramillo, S., Lyons, K., Mahmood, N., Wu, M. F., Liu, H., ... Kim, E. S. (2016). The optimal timing of surgical resection in high-risk neuroblastoma. Journal of Pediatric Surgery, 51(10), 1665-1669. https://doi.org/10.1016/j.jpedsurg.2016.05.021

The optimal timing of surgical resection in high-risk neuroblastoma. / Rojas, Yesenia; Jaramillo, Sergio; Lyons, Karen; Mahmood, Nadia; Wu, Meng Fen; Liu, Hao; Vasudevan, Sanjeev A.; Guillerman, R. Paul; Louis, Chrystal U.; Russell, Heidi V.; Nuchtern, Jed G.; Kim, Eugene S.

In: Journal of Pediatric Surgery, Vol. 51, No. 10, 01.10.2016, p. 1665-1669.

Research output: Contribution to journalArticle

Rojas, Y, Jaramillo, S, Lyons, K, Mahmood, N, Wu, MF, Liu, H, Vasudevan, SA, Guillerman, RP, Louis, CU, Russell, HV, Nuchtern, JG & Kim, ES 2016, 'The optimal timing of surgical resection in high-risk neuroblastoma', Journal of Pediatric Surgery, vol. 51, no. 10, pp. 1665-1669. https://doi.org/10.1016/j.jpedsurg.2016.05.021
Rojas, Yesenia ; Jaramillo, Sergio ; Lyons, Karen ; Mahmood, Nadia ; Wu, Meng Fen ; Liu, Hao ; Vasudevan, Sanjeev A. ; Guillerman, R. Paul ; Louis, Chrystal U. ; Russell, Heidi V. ; Nuchtern, Jed G. ; Kim, Eugene S. / The optimal timing of surgical resection in high-risk neuroblastoma. In: Journal of Pediatric Surgery. 2016 ; Vol. 51, No. 10. pp. 1665-1669.
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abstract = "Background While most high-risk neuroblastoma (HRNB) patients are enrolled in cooperative group or institutional protocols, variability exists within these protocols as to when surgical resection of the primary tumor should be performed after neoadjuvant induction chemotherapy. We sought to determine if the number of chemotherapy cycles prior to surgery affects surgical or survival outcomes in HRNB patients. Methods We performed a retrospective review of all HRNB patients < 18 years of age from 2000 to 2010, at Texas Children's Hospital. Patients were stratified based on the number of neoadjuvant induction chemotherapy cycles prior to surgical resection. Pre and post- chemotherapy tumor size, MYCN status, iodine-131-metaiodobenzylguanidine (MIBG) score at diagnosis, extent of surgical resection, estimated surgical blood loss, post-operative outcomes, and event free (EFS) and overall survival (OS) were evaluated. Data were analyzed using Wilcoxon rank-sum test, Kruskal–Wallis test, Fisher's exact test, Kaplan–Meier analyses, and Cox regression analyses. P-value < 0.05 was considered significant. Results Data from 50 patients with HRNB were analyzed. Patients were stratified by the number of cycles of chemotherapy received prior to surgery. Six patients received 2 cycles of chemotherapy (12{\%}), 20 patients received 3 cycles (40{\%}), 13 patients received 4 cycles (26{\%}), and 11 patients received 5 cycles (22{\%}) prior to surgical resection of the primary tumor. The 5-year OS was 33{\%}, 45{\%}, 83{\%} and 36{\%} in patients who received 2, 3, 4 and 5 cycles of chemotherapy prior to surgery, respectively (p = 0.07). Multivariate analysis revealed that patients who received 4 cycles of chemotherapy had a significantly lower mortality (HR: 0.11, 95{\%} CI: 0.01–0.87, p = 0.04) compared to those with 2 cycles of chemotherapy. Among the different cohorts, there were no differences with respect to MYCN status, MIBG score at diagnosis, incidence of bone marrow metastasis, extent of surgical resection, estimated blood loss, incidence of post-operative complications, or length of stay. Conclusion HRNB patients who receive 4 cycles of chemotherapy prior to surgical resection have a superior OS than patients who receive 2. Based on the superior survival of patients who received 4 cycles of chemotherapy prior to surgery, further studies are warranted to elucidate these differences.",
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T1 - The optimal timing of surgical resection in high-risk neuroblastoma

AU - Rojas, Yesenia

AU - Jaramillo, Sergio

AU - Lyons, Karen

AU - Mahmood, Nadia

AU - Wu, Meng Fen

AU - Liu, Hao

AU - Vasudevan, Sanjeev A.

AU - Guillerman, R. Paul

AU - Louis, Chrystal U.

AU - Russell, Heidi V.

AU - Nuchtern, Jed G.

AU - Kim, Eugene S.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background While most high-risk neuroblastoma (HRNB) patients are enrolled in cooperative group or institutional protocols, variability exists within these protocols as to when surgical resection of the primary tumor should be performed after neoadjuvant induction chemotherapy. We sought to determine if the number of chemotherapy cycles prior to surgery affects surgical or survival outcomes in HRNB patients. Methods We performed a retrospective review of all HRNB patients < 18 years of age from 2000 to 2010, at Texas Children's Hospital. Patients were stratified based on the number of neoadjuvant induction chemotherapy cycles prior to surgical resection. Pre and post- chemotherapy tumor size, MYCN status, iodine-131-metaiodobenzylguanidine (MIBG) score at diagnosis, extent of surgical resection, estimated surgical blood loss, post-operative outcomes, and event free (EFS) and overall survival (OS) were evaluated. Data were analyzed using Wilcoxon rank-sum test, Kruskal–Wallis test, Fisher's exact test, Kaplan–Meier analyses, and Cox regression analyses. P-value < 0.05 was considered significant. Results Data from 50 patients with HRNB were analyzed. Patients were stratified by the number of cycles of chemotherapy received prior to surgery. Six patients received 2 cycles of chemotherapy (12%), 20 patients received 3 cycles (40%), 13 patients received 4 cycles (26%), and 11 patients received 5 cycles (22%) prior to surgical resection of the primary tumor. The 5-year OS was 33%, 45%, 83% and 36% in patients who received 2, 3, 4 and 5 cycles of chemotherapy prior to surgery, respectively (p = 0.07). Multivariate analysis revealed that patients who received 4 cycles of chemotherapy had a significantly lower mortality (HR: 0.11, 95% CI: 0.01–0.87, p = 0.04) compared to those with 2 cycles of chemotherapy. Among the different cohorts, there were no differences with respect to MYCN status, MIBG score at diagnosis, incidence of bone marrow metastasis, extent of surgical resection, estimated blood loss, incidence of post-operative complications, or length of stay. Conclusion HRNB patients who receive 4 cycles of chemotherapy prior to surgical resection have a superior OS than patients who receive 2. Based on the superior survival of patients who received 4 cycles of chemotherapy prior to surgery, further studies are warranted to elucidate these differences.

AB - Background While most high-risk neuroblastoma (HRNB) patients are enrolled in cooperative group or institutional protocols, variability exists within these protocols as to when surgical resection of the primary tumor should be performed after neoadjuvant induction chemotherapy. We sought to determine if the number of chemotherapy cycles prior to surgery affects surgical or survival outcomes in HRNB patients. Methods We performed a retrospective review of all HRNB patients < 18 years of age from 2000 to 2010, at Texas Children's Hospital. Patients were stratified based on the number of neoadjuvant induction chemotherapy cycles prior to surgical resection. Pre and post- chemotherapy tumor size, MYCN status, iodine-131-metaiodobenzylguanidine (MIBG) score at diagnosis, extent of surgical resection, estimated surgical blood loss, post-operative outcomes, and event free (EFS) and overall survival (OS) were evaluated. Data were analyzed using Wilcoxon rank-sum test, Kruskal–Wallis test, Fisher's exact test, Kaplan–Meier analyses, and Cox regression analyses. P-value < 0.05 was considered significant. Results Data from 50 patients with HRNB were analyzed. Patients were stratified by the number of cycles of chemotherapy received prior to surgery. Six patients received 2 cycles of chemotherapy (12%), 20 patients received 3 cycles (40%), 13 patients received 4 cycles (26%), and 11 patients received 5 cycles (22%) prior to surgical resection of the primary tumor. The 5-year OS was 33%, 45%, 83% and 36% in patients who received 2, 3, 4 and 5 cycles of chemotherapy prior to surgery, respectively (p = 0.07). Multivariate analysis revealed that patients who received 4 cycles of chemotherapy had a significantly lower mortality (HR: 0.11, 95% CI: 0.01–0.87, p = 0.04) compared to those with 2 cycles of chemotherapy. Among the different cohorts, there were no differences with respect to MYCN status, MIBG score at diagnosis, incidence of bone marrow metastasis, extent of surgical resection, estimated blood loss, incidence of post-operative complications, or length of stay. Conclusion HRNB patients who receive 4 cycles of chemotherapy prior to surgical resection have a superior OS than patients who receive 2. Based on the superior survival of patients who received 4 cycles of chemotherapy prior to surgery, further studies are warranted to elucidate these differences.

KW - High-risk neuroblastoma

KW - Induction chemotherapy

KW - Surgical resection

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