title: Image-defined risk factors for nephrectomy in patients undergoing neuroblastoma resection.
abstract: BACKGROUND
  Although nephrectomy rates are higher in children with neuroblastoma who have image-defined risk factors and/or high-risk disease who undergo resection prior to chemotherapy, no published data outline the key radiographic and clinical characteristics associated with nephrectomy.
  
  
  METHODS
  With IRB approval, imaging studies of children undergoing primary resection of intraabdominal neuroblastoma between 2000 and 2014 were retrospectively reviewed. Fisher's exact and Wilcoxon rank-sum tests were used to compare categorical and continuous variables, respectively, with p-values adjusted for multiple testing using the false discovery rate approach.
  
  
  RESULTS
  Twenty-seven of 380 consecutive patients with CT imaging obtained prior to primary neuroblastoma resection underwent partial or total nephrectomy. On preoperative imaging, renal vessel narrowing and encasement and tumor invasion of the renal hilum, pelvis, and/or parenchyma were present significantly more frequently among patients undergoing nephrectomy. Delayed renal excretion of contrast, hydronephrosis, and tumors with MYCN amplification were also more prevalent in the nephrectomy group.
  
  
  CONCLUSIONS
  Encasement and narrowing of renal vessels, delayed excretion, and tumor invasion into the kidney, particularly pelvis and capsule invasion, are significantly associated with partial or total nephrectomy at initial neuroblastoma resection. These observations provide valuable information for surgical planning as well as presurgical discussions with families prior to neuroblastoma resection.
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Irene Isabel P
authors.initials: II
authors.lastname: Lim
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldman
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Farber
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Murphy
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Abramson
authors.affiliation: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Ellen
authors.initials: E
authors.lastname: Basu
authors.affiliation: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Stephen
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY. Electronic address: laquaglm@mskcc.org.
authors.forename: Michael P
authors.initials: MP
authors.lastname: LaQuaglia
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY.
authors.forename: Anita P
authors.initials: AP
authors.lastname: Price
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D009447:Neuroblastoma / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Image defined risk factors; Nephrectomy; Neuroblastoma; Partial nephrectomy