Neuroblastoma: Experience in One Center

Kim, Dae Yeon; Kim, Seong Chul; Kim, In Koo

Abstract

Neuroblastoma treatment remains challenging, but has been advanced by the establishment of clinical and biological variables that determine prognostic risks. Initially, stage and age were the prime determinants of survival used in clinical practice. Risk-based therapy currently is the hallmark of neuroblastoma treatment. This study reviewed the results of neuroblastoma in one center. Sixty-three patients with neuroblastoma were treated primarily at our institution from 1989 to 2003. All patients were graded according to the International Neuroblastoma Staging System (INSS) at diagnosis. There were 37 boys and 26 girls. The median age was 2.14 years (range, 33 days-10.2years). The primary site was the adrenal gland in 47, dumbbell shape extended into spinal canal in 6, retroperitoneum in 5, mediastinum in 3, and other sites in 2. The probability of 5-year overall survival (OS) and event free survival (EFS) were 46.7% and 44.2% by Kaplan-Meier method. According to INSS, there were stage 1 in 2, stage 2 in 5, stage 3 in 12, stage 4 in 42, and stage 4s in 2. There were statistically significant differences in the survival rates between patients with stage1, 2 and stage 3, 4(p<0.05). For the stage 3 and 4, the extent of surgical resection determined from the operative records and pathologic reports assessed extent of surgical resection as complete resection, no visible tumor (CR, n=17); minimal residual, visible tumor less than 5% (MR, n=15); partial resection, more residual tumor than MR (PR, n=11). The 5-year OS rate was 57.8, 51.4, and 13.6% for CR, MR, and PR. There is a trend toward higher OS with achieving the completeness of resection (p<0.05). We conclude that age and stage at diagnosis are prognostic factors, and complete excision of the primary tumor can provide better prognosis for patients with stage 3 and 4 neuroblastoma.