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

Abstract

BackgroundThe European multicenter study LNESG1 was designed to evaluate the safety and efficacy of surgical treatment alone in patients with localised neuroblastoma. In a retrospective, observational study we examined the impact of image‐defined risk factors (IDRF) on operative complications and survival (EFS and OS).Procedure534 patients with localised, non‐MYCN amplified neuroblastoma were recruited between 1995 and 1999. Group 1 consisted of 291 patients without IDRF (Stage L1 in the International Neuroblastoma Risk Group (INRG) staging system), all treated with primary surgery. Group 2: 118 patients with IDRF (INRG Stage L2), also treated with primary surgery. Group 3: 125 patients in whom primary surgery was not attempted, 106 receiving neo‐adjuvant chemotherapy.ResultsIn L1 patients (Group 1) 5‐year EFS was 92% and OS 98%. In L2 patients (Group 2 and 3) EFS was 79% and OS 89%. The differences in both EFS and OS were significant. EFS and OS in Group 2 (86% and 95%) were significantly better than 73% and 83% in Group 3. In INSS stage 1, 2 and 3, EFS were respectively 94%, 81% and 76%. Except between stage 2 and 3 the differences were significant. OS were respectively 99%, 93% and 83%, all significantly different. The 17% operative complication rate in L2 patients was significantly higher than 5% in L1 patients.ConclusionsIn localised neuroblastoma, IDRF at diagnosis are associated with worse survival rates and higher rates of operative complications. The impact of IDRF should become an integrated part of therapy planning. Pediatr Blood Cancer 2015;62:1536–1542. © 2015 Wiley Periodicals, Inc.

Characteristics and management of ganglioneuroma and ganglioneuroblastoma‐intermixed in children and adolescents

“…Therefore, we predicted that asymptomatic patients with GN and GNB‐I could be followed with observation to avoid surgical complications. IDRFs, which have been shown to predict surgical morbidities in localized NB, were detected in almost 40% of our patients and presence of an IDRF was associated with postoperative complications.…”

Laparoscopic resection of neuroblastomas in low- to high-risk patients without image-defined risk factors is safe and feasible

“…Surgical resection is a part of the multidisciplinary approach, for which it is important to decrease the general invasiveness and damage to the surrounding tissues and promptly transition to subsequent treatments [1–3]. Image-defined risk factors (IDRFs) are surgical risk factors that are evaluated according to the concepts established by the International Neuroblastoma Risk Group, as proposed by collaborative studies conducted in Europe [4, 5].…”

Implication of Image-Defined Risk Factors for the Extent of Surgical Resection and Clinical Outcome in Patients with Pelvic Neuroblastoma

“…Consequently, patients with IDRF in preoperative imaging may benefit from neoadjuvant chemotherapy. 13 Tumors exhibiting IDRF usually show a larger tumor volume, and therefore, the likelihood of a complete resection decreases with an increasing number of IDRF involved. This has been reported by Günther et al, who described in their case series with 60 patients (with abdominal NB) a significant negative correlation between the total amount of IDRF and the likelihood of radical tumor resection.…”

“…Several reports about abdominal NB describe a relationship between IDRF and larger tumor volumes and intraoperative complications. 13,[17][18][19] For instance, a large retrospective study in 534 NB patients demonstrated significantly more perioperative complications in IDRF-positive patients than in study participants without (L1). 13 The current literature regarding neurovascular complications after pelvic NB resection suggests a prevalence of 15 to 35%.…”