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Association of image-defined risk factors, tumor resectability, and prognosis in children with localized neuroblastoma

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Abstract

Background

Although localized neuroblastoma has a good prognosis, some cases have undergone treatment failure or recurrence. Apart from biologic features such as MYCN status, we wondered whether some characteristics of growing tumors are prognostic, such as a well-encapsulated mass without infiltration of vital organs. We analyzed the diagnostic utility of image-defined risk factors (IDRFs) to predict successful treatment and prognosis. The overall goal was to achieve maximum cure rates for patients with localized neuroblastoma through a better understanding of clinical characteristics.

Methods

We retrospectively reviewed the images of patients with localized neuroblastoma who were enrolled between June 1998 and December 2012 at a single institution in Shanghai, China. Unequivocal categorization regarding IDRFs was available in 67 patients. IDRF was assessed at diagnosis and after four cycles of neoadjuvant chemotherapy, on average. The median follow-up period was 84 months (range: 48–132 months) after diagnosis.

Results

MRI and CT indicated a total of 177 IDRFs in these 67 patients. Logistic regression analysis revealed a highly significant negative correlation between the numbers of IDRFs and the possibility of complete removal of neuroblastoma. Intraspinal extension of the tumor, compression of the trachea, and encasement of the main artery in localized neuroblastoma were predictors for incomplete tumor resection. According to univariate analysis, ≥ 4 IDRFs and intraspinal extension of the tumor were significant indicators of poor prognosis.

Conclusions

The number of IDRFs was useful in predicting surgical outcome and event-free survival. The number of IDRFs should be considered in protocol planning, instead of IDRF presence or absence.

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References

  1. Brodeur GM, Pritchard J, Berthold F, Carlsen NL, Castel V, Castelberry RP, et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. Prog Clin Biol Res. 1994;385:363–9.

    CAS  PubMed  Google Scholar 

  2. Meany HJ, London WB, Ambros PF, Matthay KK, Monclair T, Simmon T, et al. Significance of clinical and biologic features in stage 3 neuroblastoma: a report from the international neuroblastoma risk group project. Pediatr Blood Cancer. 2014;61:1932–9.

    Article  CAS  Google Scholar 

  3. Cohn SL, Pearson ADJ, London WB, Monclair T, Ambros PF, Brodeur GM, et al. The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force Report. J Clin Oncol. 2009;27:289–97.

    Article  Google Scholar 

  4. Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, et al. The international neuroblastoma risk Group (INRG) staging system: an INRG Task Force Report. J Clin Oncol. 2009;27:298–303.

    Article  Google Scholar 

  5. Brisse HJ, McCarville MB, Granata C, Krug KB, Wootton-Gorges SL, Kanegawa K, et al. Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project. Radiology. 2011;261:243–57.

    Article  Google Scholar 

  6. Cai JY, Tang YJ, Jiang LM, Pan C, Chen J, Tang JY, et al. Prognostic influence of minimal residual disease detected by flow cytometry and peripheral blood stem transplantation by CD34+ selection in childhood advanced neuroblastoma. Pediatr Blood Cancer. 2007;49:952–7.

    Article  Google Scholar 

  7. Chen AM, Trout AT, Towbin AJ. A review of neuroblastoma image-defined risk factors on magnetic resonance imaging. Pediatr Radiol. 2018;48:1337–47.

    Article  Google Scholar 

  8. Yoneda A, Nishikawa M, Uehara S, Oue T, Usui N, Inoue M, et al. Can neoadjuvant chemotherapy reduce the surgical risks for localized neuroblastoma patients with image-defined risk factors at the time of diagnosis? Pediatr Surg Int. 2016;32:209–14.

    Article  Google Scholar 

  9. Irtan S, Brisse HJ, Minard-Colin V, Schleiermacher G, Galmiche-Rolland L, Le Cossec C, et al. Image-defined risk factor assessment of neurogenic tumors after neoadjuvant chemotherapy is useful for predicting intra-operative risk factors and the completeness of resection. Pediatr Blood Cancer. 2015;62:1543–9.

    Article  Google Scholar 

  10. Avanzini S, Pio L, Erminio G, Granata C, Holmes K, Gambart M, et al. Image-defined risk factors in unresectable neuroblastoma: SIOPEN study on incidence, chemotherapy-induced variation, and impact on surgical outcomes. Pediatr Blood Cancer. 2017;64:e26605.

    Article  Google Scholar 

  11. Fumino S, Kimura K, Iehara T, Nishimura M, Nakamura S, Souzaki R, et al. Validity of image-defined risk factors in localized neuroblastoma: a report from two centers in Western Japan. J Pediatr Surg. 2015;50:2102–6.

    Article  Google Scholar 

  12. Yoneda A, Nishikawa M, Uehara S, Oue T, Usui N, Inoue M, et al. Can image-defined risk factors predict surgical complications in localized neuroblastoma? Eur J Pediatr Surg. 2016;26:117–22.

    PubMed  Google Scholar 

  13. Pohl A, Erichsen M, Stehr M, Hubertus J, Bergmann F, Kammer B, et al. Image-defined risk factors correlate with surgical radicality and local recurrence in patients with neuroblastoma. Klin Padiatr. 2016;228:118–23.

    Article  CAS  Google Scholar 

  14. Monclair T, Mosseri V, Cecchetto G, De Bernardi B, Michon J, Holmes K. Influence of image-defined risk factors on the outcome of patients with localised neuroblastoma. A report from the LNESG1 study of the European International Society of Paediatric Oncology Neuroblastoma Group. Pediatr Blood Cancer. 2015;62:1536–42.

    Article  Google Scholar 

  15. Günther P, Holland-Cunz S, Schupp CJ, Stockklausner C, Hinz U, Schenk JP. Significance of image-defined risk factors for surgical complications in patients with abdominal neuroblastoma. Eur J Pediatr Surg. 2011;21:314–7.

    Article  Google Scholar 

  16. Simon T, Hero B, Benz-Bohm G, von Schweinitz D, Berthold F. Review of image defined risk factors in localized neuroblastoma patients: results of the GPOH NB97 trial. Pediatr Blood Cancer. 2008;50:965–9.

    Article  Google Scholar 

  17. Irtan S, Brisse HJ, Minard-Colin V, Schleiermacher G, Canale S, Sarnacki S. Minimally invasive surgery of neuroblastic tumors in children: indications depend on anatomical location and image-defined risk factors. Pediatr Blood Cancer. 2015;62:257–61.

    Article  Google Scholar 

  18. Warmann SW, Seitz G, Schaefer JF, Scheel-Walter HG, Leuschner I, Fuchs J. Vascular encasement as element of risk stratification in abdominal neuroblastoma. Surg Oncol. 2011;20:231–5.

    Article  Google Scholar 

  19. Rich BS, McEvoy MP, Kelly NE, Oh E, Abramson SJ, Price AP, et al. Resectability and operative morbidity after chemotherapy in neuroblastoma patients with encasement of major visceral arteries. J Pediatr Surg. 2011;46:103–7.

    Article  Google Scholar 

  20. Kraal K, Blom T, van Noesel M, Kremer L, Caron H, Tytgat G, et al. Treatment and outcome of neuroblastoma with intraspinal extension: a systematic review. Pediatr Blood Cancer. 2017;64:e26451.

    Article  Google Scholar 

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Funding

This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Key Laboratory of Pediatric Hematology and Oncology, Ministry of Health, Department of Pediatric Hematology and Oncology, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine (SJTU-SM), Shanghai, China

    An-An Zhang, Ci Pan, Min Xu, Xiao-Xia Wang, Qi-Dong Ye, Yi-Jin Gao & Jing-Yan Tang

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  1. An-An Zhang
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  2. Ci Pan
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  3. Min Xu
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  4. Xiao-Xia Wang
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  6. Yi-Jin Gao
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  7. Jing-Yan Tang
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Contributions

ZAA is the first author; TJY is the corresponding author; ZAA,YQD, PC, and TYJ designed the study; XM, GYJ, and PC collected the data; WXX, PC, and ZAA reviewed the CT and MRI; ZAA, XM, and PC analyzed and interpreted the data; ZAA and GYJ drafted the manuscript; ZAA, YQD, WXX, and TJY contributed to the interpretation of results and critical revision of the manuscript for important intellectual content. All authors have read and approved the final manuscript. TJY is the study guarantor.

Corresponding author

Correspondence to Jing-Yan Tang.

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Ethical approval

This was a retrospective study. Consent was obtained from patients’ parent. No finical or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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The authors declare that there is no conflict of interest regarding the publication of this paper.

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Zhang, AA., Pan, C., Xu, M. et al. Association of image-defined risk factors, tumor resectability, and prognosis in children with localized neuroblastoma. World J Pediatr 15, 572–579 (2019). https://doi.org/10.1007/s12519-019-00274-y

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  • DOI: https://doi.org/10.1007/s12519-019-00274-y

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