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Radical Surgery Improves Survival in Patients with Stage 4 Neuroblastoma

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Abstract

Background

Neuroblastoma (NBL) is the most common extracranial solid tumor in children. Despite a good overall prognosis in NBL patients, the outcome of children with stage 4 disease, even with multimodal intensive therapy, remains poor. The role of extended surgical resection of the primary tumor is in numerous studies controversial. The aim of this study was to retrospectively analyze the impact of radical surgical resection on the overall- and event-free survival of stage 4 NBL patients.

Methods

We retrospectively analyzed patient charts of 40 patients with stage 4 NBL treated in our institution between January 1990 and May 2012. All clinical and pathological findings of stage 4 NBL patients were included. Extent of surgery was assessed from the operation records and was classified as non-radical (tumor biopsy, partial 50–90% resection) or radical (near-complete >90% resection, complete resection). Overall- (OS) and event-free (EFS) survival was assessed using the Kaplan–Meier analysis and log-rank test. A multivariate Cox regression analysis was used to demonstrate independency.

Results

In total, 29/40 patients were operated radically (>90% resection), whereas 11 patients received subtotal resection or biopsy only. OS and EFS were significantly increased in patients with radical operation compared with non-radical resection (p = 0.0003 for OS, p = 0.004 for EFS; log-rank test). A multivariate Cox regression analysis revealed radical operation as a significant and independent parameter for OS and EFS.

Conclusions

Our data indicate that radical (over 90% resection) surgery improves OS and EFS in stage 4 NBL patients.

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Acknowledgments

This study is part of the doctoral thesis work of the author Katherin Vollmer.

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Authors and Affiliations

  1. Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Katherin Vollmer, Stefan Gfroerer, Till-Martin Theilen, Udo Rolle & Henning Fiegel

  2. Department of Pediatric Hematology and Oncology, University Hospital Frankfurt, Frankfurt, Germany

    Konrad Bochennek & Thomas Klingebiel

Authors
  1. Katherin Vollmer
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  2. Stefan Gfroerer
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  3. Till-Martin Theilen
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  4. Konrad Bochennek
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  5. Thomas Klingebiel
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  6. Udo Rolle
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  7. Henning Fiegel
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Corresponding author

Correspondence to Henning Fiegel.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants (treatment of patients) are in accordance with the ethical standards of the institutional research committee and with the 1964 Helsiniki declaration and its later amendments or comparable ethical standards. For this type of study (retrospective data analysis), formal consent is not required (Ethical committee of the University Hospital Frankfurt, Decision No. 253/13).

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Vollmer, K., Gfroerer, S., Theilen, TM. et al. Radical Surgery Improves Survival in Patients with Stage 4 Neuroblastoma. World J Surg 42, 1877–1884 (2018). https://doi.org/10.1007/s00268-017-4340-9

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  • DOI: https://doi.org/10.1007/s00268-017-4340-9

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