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Survival effect of complete surgical resection of the primary tumour in patients with metastatic, high-risk neuroblastoma in a large Canadian cohort
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  • Natashia M. Seemann,
  • Craig Erker,
  • Meredith Irwin,
  • Steven R. Lopushinsky,
  • Ketan Kulkarni,
  • Conrad Fernandez,
  • Rodrigo Romao
Natashia M. Seemann
IWK Health Centre

Corresponding Author:[email protected]

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Craig Erker
IWK Health Centre
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Meredith Irwin
The Hospital for Sick Children
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Steven R. Lopushinsky
Alberta Children's Hospital
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Ketan Kulkarni
IWK Health Centre
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Conrad Fernandez
IWK Health Centre
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Rodrigo Romao
IWK Health Centre
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Purpose : To determine whether extent of surgical resection of the primary tumour correlates with survival in patients with International Neuroblastoma Staging System (INSS) stage 4, high-risk neuroblastoma. Methods : Data were extracted for patients with newly diagnosed INSS stage 4, high-risk neuroblastoma between 2001-2019 from the national Cancer in Young People in Canada (CYPC) database. Complete resection was defined as gross total resection of primary tumour based on operative reports. Primary endpoints were 3 and 5-year event-free (EFS) and overall survival (OS). Survival analyses were completed using log-rank test and Cox proportional hazards regression including covariates of age, sex, decade of treatment (2001-2009 vs. 2010-2019), immunotherapy, and tandem stem-cell transplant (SCT). Results : One-hundred and forty patients with complete surgical data were included. On univariate analysis, 3-year EFS and OS for patients that had complete vs. incomplete resection was 71% (95% CI 57-80%) vs. 48% (36-60%) and 86% (75-93%) vs. 64% (51-74%), p=0.008 and p=0.002, respectively. 5-year EFS and OS for patients with complete resection also demonstrated significantly improved survival. On Cox Proportional Hazards models adjusted for age, immunotherapy, tandem SCT and surgical resection, only complete resection was associated with statistically significant improved 3 yr EFS and OS, HR=0.48 (0.29-0.81; p=0.006) and HR=0.42 (0.24-0.73; p=0.002). Conclusions : In a large Canadian INSS stage 4 high-risk neuroblastoma cohort, complete surgical resection was associated with increased EFS and OS. Within the constraints of a retrospective study, these results suggest that the ability to achieve primary tumor complete resection in patients with metastatic high-risk disease is associated with improved survival.
13 Oct 2022Submitted to Pediatric Blood & Cancer
13 Oct 2022Submission Checks Completed
13 Oct 2022Assigned to Editor
14 Oct 2022Review(s) Completed, Editorial Evaluation Pending
15 Oct 2022Reviewer(s) Assigned
11 Nov 2022Editorial Decision: Revise Minor
31 Jan 2023Submission Checks Completed
31 Jan 2023Assigned to Editor
31 Jan 20231st Revision Received
31 Jan 2023Review(s) Completed, Editorial Evaluation Pending
31 Jan 2023Reviewer(s) Assigned
19 Feb 2023Editorial Decision: Accept