title: Review of image defined risk factors in localized neuroblastoma patients: Results of the GPOH NB97 trial.
abstract: BACKGROUND
  Recently, an international expert group proposed revision of the International Neuroblastoma Staging System (INSS). Localized disease can be classified as L1 without and as L2 with image defined risk factors (IDRF published in JCO 2005; 23:8483-8489). Our aim was to evaluate IDRF for the prediction of resectability, complications, and outcome.
  
  
  METHODS
  Records of 520 localized neuroblastoma patients of the NB97 trial were reviewed. Patients were retrospectively classified as having IDRF or not. A total of 366 evaluable patients were then analyzed for extent and complications of surgery and the prognostic value of IDRF.
  
  
  RESULTS
  Any IDRF was present in 26/160 of stage 1, 49/113 of stage 2, and 64/93 of stage 3 patients. Complete primary resection was achieved in 156/227 patients without IDRF and 43/139 patients with IDRF (P < 0.001). The frequency of complications was higher if any IDRF was present: 37/139 versus 33/227 (P = 0.006). Lack of IDRF was associated with better event free survival (3-year-EFS 86 +/- 2% vs. 75 +/- 4%, P = 0.010), whereas overall survival was similar (3-year-OS 98 +/- 1% vs. 96 +/- 2%, P = 0.462). EFS clearly depended on INSS stage (3-year-EFS 93 +/- 2% in stage 1, 78 +/- 4% in stage 2, and 69 +/- 5% in stage 3, P < 0.001). OS was not different (3-year-OS 98 +/- 1% vs. 99 +/- 1% vs. 94 +/- 2%, P = 0.056). Multivariate analysis demonstrated an impact of INSS stage on EFS only. IDRF were not shown to be significant for predicting EFS or OS.
  
  
  CONCLUSIONS
  IDRF were useful in predicting risk and completeness of operation. IDRF failed as independent risk predictors in localized neuroblastoma. INSS more precisely identified patients with poor prognosis.
authors.affiliation: Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Germany. thorsten.simon@uk-koeln.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Simon
authors.forename: Barbara
authors.initials: B
authors.lastname: Hero
authors.forename: Gabriele
authors.initials: G
authors.lastname: Benz-Bohm
authors.forename: Dietrich
authors.initials: D
authors.lastname: von Schweinitz
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate