Abstract：
BACKGROUND: Image-defined risk factors (IDRFs) were promulgated for predicting the feasibility and safety of complete primary tumor resection in children with neuroblastoma (NB). There is limited understanding of the impact of individual IDRFs on resectability of the primary tumor or patient outcomes. A multicenter database of patients with high-risk NB was interrogated to answer this question.
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.
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.
摘要：
背景：公布了图像定义的危险因素（IDRFs），用于预测神经母细胞瘤（NB）儿童完全切除原发性肿瘤的可行性和安全性。关于单个IDRF对原发肿瘤可切除性或患者预后的影响的理解有限。询问了高风险NB患者的多中心数据库以回答此问题。
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。
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。
