title: Value of surgical resection in children with high-risk neuroblastoma.
abstract: BACKGROUND
  The value of gross total resection (GTR) for children with high-risk neuroblastoma (NB) is controversial. We hypothesized that patients undergoing GTR would demonstrate improved overall survival (OS) compared those having <GTR.
  
  
  METHODS
  Using a single institutional database, we reviewed the medical records of all children with high-risk NB undergoing hematopoietic stem cell transplantation (HSCT) as part of multimodality therapy from 1990 to 2012. Children had received surgical care at multiple institutions (n = 14) prior to HSCT and were divided into two groups based on extent of surgical resection: GTR (no visible or palpable disease at end of operation) and <GTR (no surgery, biopsy only, or subtotal resection). Kaplan-Meier curves and Cox hazards models evaluated differences in overall survival (OS).
  
  
  RESULTS
  One hundred four children underwent HSCT, and 87 (83.6%) had adequate data for analysis. Thirty eight percent had GTR while 62% had <GTR prior to HSCT. There was no significant difference in OS in patients undergoing GTR compared to <GTR (Log rank test: P = 0.49). Post-hoc analysis demonstrated a survival advantage for patients undergoing >90% resection compared to <90% resection (P = 0.008). Multivariable Cox models confirmed these findings with improved survival in children undergoing >90% vs. <90% resection but no difference in GTR vs. <GTR.
  
  
  CONCLUSIONS
  Gross total resection prior to HSCT in high-risk NB patients is not associated with improved OS compared to <GTR; however, these results suggest that >90% resection is associated with improved OS compared to less than 90% resection.
authors: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors: Brian R
authors: BR
authors: Englum
authors: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors: Kristy L
authors: KL
authors: Rialon
authors: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors: Paul J
authors: PJ
authors: Speicher
authors: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
authors: Brian
authors: B
authors: Gulack
authors: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors: Timothy A
authors: TA
authors: Driscoll
authors: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors: Susan G
authors: SG
authors: Kreissman
authors: Department of Surgery, Duke University School of Medicine, Durham, North Carolina.|Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors: Henry E
authors: HE
authors: Rice
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D000315:Adrenalectomy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D020360:Neoadjuvant Therapy; D009447:Neuroblastoma / Q000188:drug therapy / Q000453:epidemiology / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D012189:Retrospective Studies; D012306:Risk; D015983:Selection Bias; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: BMT for malignant conditions; Surgery; neuroblastoma; sickle cell