Changes in image-defined risk factors with neoadjuvant chemotherapy in pediatric abdominal neuroblastoma

Impact of pre-treatment extracellular volume fraction measured by computed tomography on response of primary lesion to preoperative chemotherapy in abdominal neuroblastoma

OBJECTIVES

To retrospectively investigate the impact of pre-treatment Extracellular Volume Fraction (ECV) measured by Computed Tomography (CT) on the response of primary lesions to preoperative chemotherapy in abdominal neuroblastoma.

METHODS

A total of seventy-five patients with abdominal neuroblastoma were retrospectively included in the study. The regions of interest for the primary lesion and aorta were determined on unenhanced and equilibrium phase CT images before treatment, and their average CT values were measured. Based on patient hematocrit and average CT values, the ECV was calculated. The correlation between ECV and the reduction in primary lesion volume was examined. A receiver operating characteristic curve was generated to assess the predictive performance of ECV for a very good partial response of the primary lesion.

RESULTS

There was a negative correlation between primary lesion volume reduction and ECV (r = -0.351, p = 0.002), and primary lesions with very good partial response had lower ECV (p < 0.001). The area under the curve for ECV in predicting the very good partial response of primary lesion was 0.742 (p < 0.001), with a 95 % Confidence Interval of 0.628 to 0.836. The optimal cut-off value was 0.28, and the sensitivity and specificity were 62.07 % and 84.78 %, respectively.

CONCLUSIONS

The measurement of pre-treatment ECV on CT images demonstrates a significant correlation with the response of the primary lesion to preoperative chemotherapy in abdominal neuroblastoma.

Image-defined risk factors associated with MYCN oncogene amplification in neuroblastoma and their association with overall survival

OBJECTIVE

The MYCN oncogene is a critical factor in the development and progression of neuroblastoma, and image-defined risk factors (IDRFs) are radiological findings used for the preoperative staging of neuroblastoma. This study aimed to investigate the specific categories of IDRFs associated with MYCN amplification in neuroblastoma and their association with overall survival.

METHOD

A retrospective analysis was conducted on a cohort of 280 pediatric patients diagnosed with neuroblastoma, utilizing a combination of clinical and radiological data. MYCN amplification status was ascertained through molecular testing, and the assessment of IDRFs was conducted using either contrast-enhanced computed tomography or magnetic resonance imaging. The specific categories of IDRFs associated with MYCN amplification and their association with overall survival were analyzed.

RESULTS

MYCN amplification was identified in 19.6% (55/280) of patients, with the majority of primary lesions located in the abdomen (53/55, 96.4%). Lesions accompanied by MYCN amplification exhibited significantly larger tumor volume and a greater number of IDRFs compared with those without MYCN amplification (P < 0.001). Both univariate and multivariate analyses revealed that coeliac axis/superior mesenteric artery encasement and infiltration of adjacent organs/structures were independently associated with MYCN amplification in abdominal neuroblastoma (P < 0.05). Patients presenting with more than four IDRFs experienced a worse prognosis (P = 0.017), and infiltration of adjacent organs/structures independently correlated with overall survival in abdominal neuroblastoma (P = 0.009).

CONCLUSION

The IDRFs are closely correlated with the MYCN amplification status and overall survival in neuroblastoma.

Contrast-enhanced computed tomography radiomics in predicting primary site response to neoadjuvant chemotherapy in high-risk neuroblastoma

PURPOSE

To explore the clinical value of contrast-enhanced computed tomography (CECT) radiomics in predicting primary site response to neoadjuvant chemotherapy in high-risk neuroblastoma.

MATERIALS AND METHODS

Seventy patients were retrospectively included and separated into very good partial response (VGPR) group and non-VGPR group according to the changes in primary tumor volume. The clinical features with statistical difference between the two groups were used to construct the clinical models using a logistic regression (LR) algorithm. The radiomics models based on different radiomics features selected by Kruskal-Wallis (KW) test and recursive feature elimination (RFE) were established using support vector machine (SVM) and LR algorithms. The radiomics score (Radscore) and clinical features were integrated into the combined models. Leave-one-out cross-validation (LOOCV) was used to validate the predictive performance of models in the entire dataset.

RESULTS

The optimal clinical model achieved an area under the curve (AUC) of 0.767 [95% confidence interval (CI): 0.638, 0.896] and an accuracy of 0.771 after LOOCV. The AUCs of the best KW + SVM, KW + LR, RFE + SVM, and RFE + LR radiomics models were 0.816, 0.826, 0.853, and 0.850, respectively, and the corresponding AUCs after LOOCV were 0.780, 0.785, 0.755, and 0.772, respectively. The AUC and accuracy after LOOCV of the optimal combined model was 0.804 (95% CI: 0.694, 0.915) and 0.814, respectively. The Delong test showed a statistical difference in predictive performance between the optimal clinical and combined models after LOOCV (Z = 2.003, P = 0.045). The decision curve analysis showed that the combined model performs better than the clinical model.

CONCLUSION

The CECT radiomics models have a favorable predictive performance in predicting VGPR of high-risk neuroblastoma to neoadjuvant chemotherapy. When integrating radiomics features and clinical features, the predictive performance of the combined models can be further improved.

The Use of Cavitron Ultrasonic Surgical Aspirator for High-Risk Neuroblastoma with Image-Defined Risk Factors in Children

Aim of the study: The cavitron ultrasonic surgical aspirator (CUSA) has gained popularity in adult surgical oncology, but its application in children is limited to liver surgery and neurosurgical procedures. The complete resection of neuroblastoma with image-defined risk factors (IDRFs) is still considered one of the most difficult procedures to achieve in pediatric surgical oncology, with a high morbidity rate and potential risk of intraoperative mortality. The aim of our study is to describe the application of ultrasonic dissection in neuroblastoma with IDRFs. Methods: A retrospective study was performed, analyzing patients operated on from 2000 to 2018. Patient characteristics, resection completeness, and postoperative surgical and oncology outcomes were analyzed. Main results: Twenty-six patients with high-risk neuroblastoma and IDRFs were operated on in the study period with a CUSA. A complete macroscopic resection was performed in 50% of patients, while the other half was operated on with minimal residual (<5 mL). Six post-operative complications occurred without the need for surgery (Clavien−Dindo < 3). The overall survival was 50%, with a median follow-up of 69.6 months (5.6−140.4). Conclusions: The application of the CUSA in neuroblastoma with IDRFs can be considered an effective and safe alternative technique to achieve a radical resection.