title: Surgical treatment of neuroblastoma: twenty-three years of experience at a single institution.
abstract: OBJECTIVE
  Neuroblastoma (NB) is treated with surgery, chemotherapy and radiotherapy. We assessed the effects of surgical resection on the outcome over a 23-year period at our institution.
  
  
  METHODS
  85 children were included with a median age at diagnosis of 2.0 (range 0.1-15) years. We assessed the correlation of the complete surgical resection (CR) rate, metastases, NMYC amplification (NMYCA) and chemotherapeutic response with the 5-year overall survival (OS).
  
  
  RESULTS
  The INSS stage of NB was 1 in 11 (13 %) patients, 2 in 10 (11 %), 3 in 13 (17 %), 4 in 46 (53 %) and 4S in five patients (6 %). Fifty-two (61 %) patients had high-risk NB and 22 (26 %) had NMYCA. The resection was complete in 72 (85 %) patients, incomplete (ICR) in seven (8 %) and six (7 %) patients did not undergo surgery. Fifty-five patients were administered neoadjuvant and 61 were administered adjuvant chemotherapy (high-dose, n = 50). The OS (5 year) was 68 %: stage 1 (100 %), 2 (90 %), 3 (77 %), 4 (52 %), 4S (80 %) and high-risk NB (52 %). The OS in high-risk NB patients was correlated with a good chemotherapeutic response of the primary tumour, with a RR for mortality = 0.3 (95 % CI 0.1-0.7; p = 0.01), but not with the CR, which had an RR = 0.9 (95 % CI 0.3-2.4; p = 0.84).
  
  
  CONCLUSIONS
  The OS in high-risk NB patients was related to a good histological chemotherapeutic response, but not with complete excision of the primary tumour.
authors.affiliation: Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland, antti.koivusalo@hus.fi.
authors.forename: A I
authors.initials: AI
authors.lastname: Koivusalo
authors.forename: M P
authors.initials: MP
authors.lastname: Pakarinen
authors.forename: R J
authors.initials: RJ
authors.lastname: Rintala
authors.forename: U M
authors.initials: UM
authors.lastname: Saarinen-Pihkala
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D007223:Infant; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010750:Phosphoproteins; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D029867:Xenopus Proteins
chemical_list: D000970:Antineoplastic Agents; C519842:EIAP protein, Xenopus; D010750:Phosphoproteins; D029867:Xenopus Proteins