title: Does aggressive surgical resection improve survival in advanced stage 3 and 4 neuroblastoma? A systematic review and meta-analysis.
abstract: The role of surgery in the management of advanced staged neuroblastoma (NBL) is controversial. A systematic review and meta-analysis is reported to address robust evidence for curative "gross total tumor resection" (GTR) in Stage 3 and Stage 4 neuroblastoma. Studies were identified using Medline, Embase, and Cochrane databases using pre-specified search terms. Primary outcomes were 5-year overall (OS) and disease-free survival (DFS) after GTR and subtotal resection (STR) in Stage 3 or 4 NBL. Data were analyzed using Review Manager. The Mantel-Haenszel method and a random effects model was utilized to calculate odds ratios (95% CI). Fifteen studies (five Stage 3 and 13 Stage 4) met full inclusion criteria. The pooled odds ratio for 5 year OS in Stage 3 following GTR compared to STR was 2.4 (95% CI 1.19-4.85). In Stage 4 disease, the pooled odds ratio for 5 year overall survival (OS) following GTR compared to STR was 1.65 (95% CI 0.96-1.91); a pooled odds ratio for 5 year DFS following GTR compared to STR was 1.55 (95% CI 1.12-2.14). A clear survival benefit is shown for GTR over STR in Stage 3 NBL only. Though some advantage can be demonstrated for GTR as defined by DFS in Stage 4 NBL GTR did not significantly improve OS in Stage 4 disease.
authors.affiliation: Academic Department of Paediatric Surgery, Alder Hey Children's Hospital, NHS Trust University of Liverpool , UK.
authors.forename: Dhanya
authors.initials: D
authors.lastname: Mullassery
authors.forename: Paul
authors.initials: P
authors.lastname: Farrelly
authors.forename: Paul D
authors.initials: PD
authors.lastname: Losty
mesh_terms: D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004739:England; D006801:Humans; D007223:Infant; D009447:Neuroblastoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: children; evidence based medicine; neuroblastoma; stage 3 neuroblastoma; stage 4 neuroblastoma; surgery