title: Image-defined Risk Factors Correlate with Surgical Radicality and Local Recurrence in Patients with Neuroblastoma.
abstract: BACKGROUND
  Neuroblastoma is the second most common solid pediatric tumor and the most common cancer to be detected in children younger than 12 months of age. To date, 2 different staging systems describe the extent of the disease: the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Risk Group Staging System (INRGSS). The INRGSS-system is characterized by the presence or absence of so called image-defined risk factors (IDRFs), which are described as surgical risk factors. We hypothesized that IDRFs correlate with surgical complications, surgical radicality, local recurrence and overall survival (OS).
  
  
  METHODS
  Between 2003 and 2010, 102 patients had neuroblastoma surgery performed in our department. We analyzed medical records for IDRF-status and above named data.
  
  
  RESULTS
  16 patients were IDRF-negative, whereas 86 patients showed one or more IDRF. Intra- or postoperative complications have been reported in 21 patients (21%). 19 of them showed one or more IDRF and 2 patients were IDRF-negative (p=n.s.). Patients who suffered from intra- or postoperative complications demonstrated a decreased OS (p=0.011). Statistical analysis revealed an inverse correlation between the extent of macroscopical removal and IDRF-status (p=0.001). Furthermore, the number of IDRFs were associated with a decreased likelihood of radical tumor resection (p<0.001). 19 patients had local recurrence; all of them were IDRF-positive (p=0.037).
  
  
  CONCLUSIONS
  Pediatric surgeons should consider IDRFs as a useful tool for risk assessment and therefore planning for neuroblastoma surgery.
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauners' childrens hospital, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Pohl
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauners' childrens hospital, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Erichsen
authors.affiliation: Department of Pediatric Surgery, Cnopf'sche Children's Clinic, Nuremberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Stehr
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauners' childrens hospital, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hubertus
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauners' childrens hospital, Munich, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Bergmann
authors.affiliation: Institute for Clinical Radiology, Dr. von Haunersches Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Kammer
authors.affiliation: Department of Pediatric Surgery, Dr. von Hauners' childrens hospital, Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: von Schweinitz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D018570:Risk Assessment; D013223:Statistics as Topic; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult