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Association of Image-Defined Risk Factors with Clinical, Biological Features and Outcome in Neuroblastoma. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111707. [PMID: 36360435 PMCID: PMC9688519 DOI: 10.3390/children9111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
Background: Neuroblastoma (NB) is the most common pediatric extracranial solid tumor and the most common cancer encountered in children younger than 12 months of age. Localized tumors have a good prognosis, but some cases undergo treatment failure and recurrence. The aim of the study was to analyze the link between the neuroblastoma risk factors and the prognosis for patients diagnosed with NB. Method: All patients admitted to the department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, between 1 January 2010 and 1 July 2022 were included in this analysis when diagnosed with neuroblastoma. Results: Thirty-one patients with NB were admitted to the surgical department, 20 boys and 11 girls. We observed an association between large tumors and positive imaging-defined risk factor (IDRF) status; The Fisher test showed an association between the tumor’s diameter when bigger than 8 cm and a positive IDRF status, with p < 0.001. We supposed that positive IDRF status at diagnosis may be linked to other prognostic factors. We discovered that an NSE value over 300 was associated with IDRF status (p < 0.001, phi = 0.692) and death. Conclusions: This study confirms the impact of IDRF status at diagnosis as it can be clearly correlated with other risk factors, such as a high level of NSE, MYCN amplification status, large tumor size, incomplete tumor resection, and an unfavorable outcome.
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梁 伟, 叶 小, 钟 共, 陈 建, 戴 康, 卓 家, 莫 姝, 王 博, 李 春, 蒋 轩, 徐 志, 周 黎, 陈 秀, 陈 健, 朱 知, 李 珮, 陈 志. [Clinical efficacy of combined therapy in children with stage 4 neuroblastoma]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:759-764. [PMID: 35894190 PMCID: PMC9336616 DOI: 10.7499/j.issn.1008-8830.2203049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/06/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma. METHODS A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021. RESULTS The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years. CONCLUSIONS Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.
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Affiliation(s)
| | | | | | | | | | - 家良 卓
- 香港大学玛丽医院 儿童及青少年科学系,香港
- 香港儿童医院,香港
| | | | | | | | | | - 志渊 徐
- 香港大学大学深圳医院放疗科, 广东深圳518000
| | | | | | | | | | - 珮华 李
- 香港大学深圳医院儿科,广东深圳518000
- 香港大学玛丽医院 儿童及青少年科学系,香港
- 香港儿童医院,香港
| | - 志峰 陈
- 香港大学深圳医院儿科,广东深圳518000
- 香港大学玛丽医院 儿童及青少年科学系,香港
- 香港儿童医院,香港
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Zhang R, Fang YF, Wu DM, Lin Y, Zhang B, Liu MK, Bai JX, Chen F. Comparison of the Efficacy of Minimally Invasive and Open Surgery on Children with Neuroblastoma: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 31:829-838. [PMID: 34076504 DOI: 10.1089/lap.2020.0618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Evaluate the clinical efficacy and safety of minimally invasive surgery (MIS) and open surgery in the treatment of neuroblastoma (NB) in children by a meta-analysis. Materials and Methods: This is a meta-analysis. We searched for random or nonrandomized controlled study of MIS group and OPEN surgery group for the treatment of childhood NB included in PubMed, ClinicalTrials, EMBASE, and Cochrane library before January 31, 2020. Data extraction was performed in a standard format for the included studies, including tumor diameter, operation time, intraoperative bleeding, length of hospital stay (LOHS), complications, recurrence, and MYCN. Results: Seven retrospective studies were finally included, with a total of 571 children, including 162 in MIS group and 409 in the OPEN surgery group. Compared with the OPEN surgery group, the MIS group had reduced intraoperative bleeding (mean difference [MD] = -12.72, 95% CI: -24.84 to -0.61, P < .05), and reduced l LOHS (MD = -3.35, 95% CI: -5.55 to -1.15, P < .05) and decreased postoperative recurrence (MD = 0.20, 95% CI: 0.05-0.75, P < .05). The differences between the groups were statistically significant. There was no significant difference between groups in tumor diameter (MD = -18.84, 95% CI: -48.12 to 10.43, P > .05), operation time (MD = -21.7, 95% CI: -97.52 to 54.13, P > .05), and MYCN results (odds ratio = 2.27, 95% CI: 0.56-9.18, P > .05). Conclusions: Preliminary evidence indicates that the treatment of NB with MIS has the advantages of less intraoperative bleeding, shorter LOHS, and less postoperative recurrence compared with open surgery.
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Affiliation(s)
- Rong Zhang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Yi Fan Fang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Dian Ming Wu
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Yu Lin
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Bing Zhang
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Ming Kun Liu
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Jiang Xi Bai
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
| | - Fei Chen
- Department of Pediatric Surgery, Fujian Province Maternal and Child Health Hospital, Fuzhou, China
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Ma X, Duan C, Cai S, Wang X, Jiang C, Yue Z, Li K, Jin M, Zhang D, Wang X, Peng X. The development and initial evaluation of referral flowchart for suspected neuroblastoma for pediatricians in nononcology clinics in China. Pediatr Blood Cancer 2021; 68:e28869. [PMID: 33381885 DOI: 10.1002/pbc.28869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND The delayed diagnosis of neuroblastoma (NB) is common in China, which results in the prognosis of NB in China lagging behind that in developed countries. METHODS A referral flowchart for suspected NB was implemented in nononcology clinics at Beijing Children's Hospital (BCH). Patients with symptoms of suspected NB were referred from nononcology clinics in BCH to oncology clinics and confirmed NB cases were regarded as referral group. The control group comprised patients initially diagnosed with NB who came directly to oncology clinics in BCH from other regions nationwide. The age at NB diagnosis was compared as primary outcome, and the 5-year overall survival (OS) and event-free survival (EFS) were compared via the Kaplan-Meier method and log-rank tests. RESULTS In total, 3337 children with suspected NB were screened consecutively from 687 070 pediatric patients. Through examination of urine vanillylmandelic acid and homovanillic acid, or B-ultrasound, 102 of 3337 patients were referred to oncologists for comprehensive evaluations. Eventually, 29 referred patients were diagnosed as NB and the hospital-based diagnosis rate of NB was 4.2 per 100 000 visits. The median age at diagnosis in the referral group was 21.0 months, which was 9 months earlier than that of the control group (30.0 months, P = .026). The 5-year OS rate was 72.4% in the referral group, which was higher than that of the control group (66.7%) but without statistical significance (P = .664). CONCLUSION Delayed NB detection could be avoided by training pediatricians in nononcology clinics to detect suspected NB and refer these patients to oncologists.
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Affiliation(s)
- Xiaoli Ma
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Chao Duan
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Siyu Cai
- Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, National Center for Children's Health, Key Laboratory of Major Diseases in Children, Ministry of Education, Capital Medical University, Beijing, China
| | - Xindi Wang
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Chiyi Jiang
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhixia Yue
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kun Li
- Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, National Center for Children's Health, Key Laboratory of Major Diseases in Children, Ministry of Education, Capital Medical University, Beijing, China
| | - Mei Jin
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Dawei Zhang
- Hematology Oncology Center, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, MOE Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoman Wang
- Ultrasound Department, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology & Evidence-based Medicine, Beijing Children's Hospital, National Center for Children's Health, Key Laboratory of Major Diseases in Children, Ministry of Education, Capital Medical University, Beijing, China
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Impact of extent of resection on survival in high-risk neuroblastoma: A systematic review and meta-analysis. J Pediatr Surg 2019; 54:1487-1494. [PMID: 30262202 DOI: 10.1016/j.jpedsurg.2018.08.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients is still poor. Many studies designed to elaborate the association between the extent of resection (EOR) and outcome have reported conflicting results. We performed a meta-analysis to assess whether greater EOR is associated with improved overall survival (OS) and event-free survival (EFS) in patients with high-risk neuroblastoma. METHODS Embase, PubMed, Cochrane library, and conference proceedings were searched between March 10 and October 1, 2017. Studies of pediatric patients with newly diagnosed high-risk neuroblastoma comparing various EOR and presenting objective overall or event-free survival data were included. Primary outcomes were relative risk (RR) for mortality at 3 and 5 years. Secondary outcomes were 3-year and 5-year EFS rates. RESULTS 19 retrospective studies including a total of 2358 cases were identified. Compared with subtotal resection (STR), patients who underwent gross total resection (GTR) had significantly decreased mortality at 3 years (RR, 0.69; 95% CI, 0.58-0.82; P < 0.001; I2 = 27%) and 5 years (RR, 0.70; 95% CI, 0.60-0.82; P < 0.001; I2 = 38%). A similar decrease was revealed in the 3-year risk for mortality for STR compared with biopsy (RR, 0.71; 95% CI, 0.53-0.95; P = 0.02; I2 = 0%). When comparing any resection with biopsy, resection group also showed a decreased risk for mortality at 3 years (RR, 0.66; 95% CI, 0.53-0.83; P < 0.001; I2 = 8%) and 5 years (RR, 0.67; 95% CI, 0.50-0.91; P = 0.009; I2 = 61%). With respect to the risk ratio for EFS, there were no significant differences in any comparisons. CONCLUSION This literature highlights the importance of "extent of resection" in treating high-risk neuroblastoma, and when feasible, the currently available evidences in favor of the use of GTR for high-risk neuroblastoma for reducing 3- and 5-year mortality. LEVEL OF EVIDENCE 3A.
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Luo YB, Cui XC, Yang L, Zhang D, Wang JX. Advances in the Surgical Treatment of Neuroblastoma. Chin Med J (Engl) 2018; 131:2332-2337. [PMID: 30246719 PMCID: PMC6166470 DOI: 10.4103/0366-6999.241803] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study was to review the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma (NB). DATA SOURCES The online database ScienceDirect (201-2018) was utilized. The search was conducted using the keywords "neuroblastoma," "neuroblastoma resection," "neuroblastoma surgery," and "high-risk neuroblastoma." STUDY SELECTION We retrospectively analyzed of patients who underwent surgical resections in different clinical situations. The article included findings from selected relevant randomized controlled trials, systematic reviews, and meta-analyses or good-quality observational studies. Abstracts only, letters, and editorial notes were excluded. Full-text articles and abstracts were extracted and reviewed to identify key articles discussing surgery management of NB, which were then selected for critical analysis. RESULTS A total of 7800 English language articles were found containing references to NB (201-2018). The 163 articles were searched which were related to the surgical treatment of NB (201-2018). Through the analysis of these important articles, we found that the treatments of NB at low- and intermediate-risk groups were basically the same. High-risk patients remained controversial. CONCLUSIONS NB prognosis varies tremendously based on the stage and biologic features of the tumor. After reviewing the relevant literature, patients with low-risk disease are often managed with surgical resection or observation alone with tumors likely to spontaneously regress that are not causing symptoms. Intermediate patients are treated with chemotherapy with the number of cycles depending on their response as well as surgical resection of the primary tumor. High-risk patients remain controversial. Multidisciplinary intensive treatment is essential, especially for patients who received subtotal tumor resection. Minimally invasive surgery for the treatment of NBs without image-defined risk factors in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome. We conclude that ≥90% resection of the primary tumor is both feasible and safe in most patients with high-risk NB. New targeted therapies are crucial to improve survival.
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Affiliation(s)
- Yan-Bing Luo
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Xi-Chun Cui
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Lin Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Da Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Jia-Xiang Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China
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