Resection of primary tumor in stage 4S neuroblastoma: a second study by the Italian Neuroblastoma Group
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In brief
In brief
This Italian study of 172 infants with stage 4S neuroblastoma found significantly better 5-year survival in patients who underwent upfront primary tumor resection versus observation (96.8% vs 85.7% overall survival). While selection bias limits definitive conclusions about surgery's benefit, the study emphasizes obtaining adequate tumor tissue for biological studies to guide treatment decisions in this favorable-prognosis infant cancer subtype.
Written by the GCMD Library team from the article.
Abstract
Purpose
To clarify the role of primary tumor resection in stage 4S neuroblastoma.
Methods
We investigated a cohort of 172 infants diagnosed with stage 4S neuroblastoma between 1994 and 2013. Of 160 evaluable patients, 62 underwent upfront resection of the primary tumor and 98 did not.
Results
Five-year progression-free and overall survival were significantly better in those who had undergone upfront surgery (83.6% vs 64.2% and 96.8% vs 85.7%, respectively). One post-operative death and four non-fatal complications occurred in the resection group. Three patients who had not undergone resection died of chemotherapy-related toxicity. Thirteen patients underwent late surgery to remove a residual tumor, without complications: all but one alive. Outcomes were better in patients diagnosed from 2000 onwards.
Conclusion
Infants diagnosed with stage 4S neuroblastoma who underwent upfront tumor resection had a better outcome. However, this result cannot be definitely attributed to surgery, since these patients were selected on the basis of their favorable presenting features. Although the question of whether to operate or not at disease onset is still unsolved, this study confirms the importance of obtaining enough adequate tumor tissue to enable histological and biological studies to properly address treatment, to achieve the best possible outcome.