The impact of surgical intervention on survival in stage IV neuroblastoma

Objective The implications of surgical intervention for neuroblastoma of stage Ⅳ were assessed.Methods We analyzed the clinical characteristics and extent of resection in 59 pediatric patients who were diagnosed neuroblastoma stage Ⅳ and had complete follow-up data between 2002 and 2010 in the Cancer Institute and Hospital of Tianjin Medical University.There were 17 cases whose parents did not agree to the resection of the primary tumor and 9 cases who accepted subtotal resection.33 cases had complete gross resection,including 10 cases who had macroscopic residue and 23 cases who had microscopic clear margin.Results The median overall survival time of the 59 patients with the follow-up data was 23 months (CI: 1-96 months).The median age of these patients was 41 months (CI: 13-118 months).The effective rate of induction chemotherapy was 87.5％ and the rate of complete resection was 68.8％.The 2-year survival rate in the no surgery group was 14.2％,and in the subtotal resection group was 44.4％ and in the complete resection group was 54.2％ respectively.Kaplan-Meier curve showed that no surgery group (Median survival 10 months) had a lower survival rate than the subtotal resection group (Median survival 24 months) and the complete resection group (Median survival 33 months).Log-rank test showed significant statistical difference between no surgery group and the complete resection group (P＜0.000) and also was seen between no surgery group and the subtotal resection group (P =0.002).Kaplan-Meier curves showed that in the complete resection group,the microscopic clear margin group (Median survival 33 months) did not have a higher survival rate than the microscopic residual group (Median survival 22 months). No statistical difference was seen between the two groups(P =0.593).Conclusions Induction chemotherapy can improve the complete resection rate of neuroblastoma stage Ⅳ.When complete resection was the intention,there is no difference of the survival rate whether there is microscopic clear margin or not. Key words: Neuroblastoma; Surgical procedures,operative; Survival rate