The influence of biologic factors on the surgical decision in advanced neuroblastoma.
BACKGROUND
Molecular markers greatly affect the outcome of neuroblastoma. This study evaluated the influence of Trk-A and myelocytomatosis viral-related oncogene, neuroblastoma-derived (MYCN) on the role of surgery in advanced neuroblastoma.


METHODS
Ten stage 3 and 35 stage 4 neuroblastoma patients were included. Tumor resection was classified into gross total resection (GTR) and incomplete resection. Patients were classified into three biological risk groups according to Trk-A expression and myelocytomatosis viral-related oncogene, neuroblastoma-derived (MYCN) status in tumor tissues studied by immunohistochemistry and fluorescence in situ hybridization, respectively: low risk (positive Trk-A and normal MYCN), intermediate risk (negative Trk-A and normal MYCN), and high risk (positive or negative Trk-A and MYCN amplification). The effect of tumor resection on prognosis was studied and stratified according to the risk grouping.


RESULTS
GTR was achieved in 21 patients (46.7%) with a higher complication rate (33% vs. 8% in the incomplete resection group, P = .036). GTR was easier to achieve in low-risk tumors than in intermediate- or high-risk tumors (12 of 13, 4 of 17, and 5 of 15, respectively; P < .001). GTR predicted a favorable prognosis for intermediate-risk patients (P = .037; log-rank test), but not for low- or high-risk patients because of the overall favorable and poor prognosis, respectively.


CONCLUSIONS
GTR carries a potentially higher possibility of complication. Although GTR can be achieved easily in low-risk neuroblastoma patients with a favorable prognosis, surgeons should do their best to achieve GTR for intermediate-risk patients to improve outcome. Nevertheless, sacrificing vital organs to achieve GTR for high-risk patients is not justified.
Hsu
Wen-Ming
WM
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, #7 Chung-Shan South Road, Taipei 100, Taiwan.
Jen
Yung-Ming
YM
Lee
Hsinyu
H
Kuo
Min-Liang
ML
Tsao
Po-Nien
PN
Chen
Chiung-Nien
CN
Lai
Dar-Ming
DM
Lin
Ming-Tsan
MT
Lai
Hong-Shiee
HS
Chen
Wei-Jao
WJ
Hsieh
Fon-Jou
FJ
D014408:Biomarkers, Tumor / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D000071447:N-Myc Proto-Oncogene Protein; D009447:Neuroblastoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D009687:Nuclear Proteins / Q000378:metabolism*; D015513:Oncogene Proteins / Q000378:metabolism*; D011379:Prognosis; D016016:Proportional Hazards Models; D020917:Receptor, trkA / Q000378:metabolism*; D018570:Risk Assessment; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
D014408:Biomarkers, Tumor; C459801:MYCN protein, human; D000071447:N-Myc Proto-Oncogene Protein; D009687:Nuclear Proteins; D015513:Oncogene Proteins; D020917:Receptor, trkA