METHODS: Patients with high-risk NB (age <20 years) were eligible if cross-sectional imaging was performed at least twice prior to resection. IDRFs and primary tumor measurements were recorded for each imaging study. Extent of resection was determined from operative reports.
RESULTS: There were 211 of 229 patients with IDRFs at diagnosis, and 171 patients with IDRFs present pre-surgery. A ≥90% resection was significantly more likely in the absence of tumor invading or encasing the porta hepatis, hepatoduodenal ligament, superior mesenteric artery (SMA), renal pedicles, abdominal aorta/inferior vena cava (IVC), iliac vessels, and/or diaphragm at diagnosis or an overlapping subset of IDRFs (except diaphragm) at pre-surgery. There were no significant differences in event-free survival (EFS) and overall survival (OS) when patients were stratified by the presence versus absence of any IDRF either at diagnosis or pre-surgery.
CONCLUSIONS: Two distinct but overlapping subsets of IDRFs present either at diagnosis or after induction chemotherapy significantly influence the probability of a complete resection in children with high-risk NB. The presence of IDRFs was not associated with significant differences in OS or EFS in this cohort.
方法:高危NB患者(年龄<20岁)如果在切除前至少进行两次横断面成像,则符合资格。记录每个成像研究的IDRF和原发性肿瘤测量值。根据手术报告确定切除程度。
结果:229例诊断为IDRF的患者中有211例,171名IDRFs患者在手术前。在没有肿瘤侵入或包裹肝门的情况下,切除≥90%的可能性更大。肝十二指肠韧带,肠系膜上动脉(SMA),肾蒂,腹主动脉/下腔静脉(IVC),髂血管,和/或诊断时的隔膜或手术前的IDRF重叠子集(隔膜除外)。当患者在诊断或术前根据是否存在任何IDRF进行分层时,无事件生存率(EFS)和总生存率(OS)没有显着差异。
结论:诊断时或诱导化疗后存在的两个不同但重叠的IDRFs亚群显著影响高危NB患儿完全切除的概率。在该队列中,IDRFs的存在与OS或EFS的显着差异无关。