TY - JOUR
T1 - Impact of extent of resection on local control and survival in patients from the COG A3973 study with high-risk neuroblastoma
AU - Von Allmen, Daniel
AU - Davidoff, Andrew M.
AU - London, Wendy B.
AU - Van Ryn, Collin
AU - Haas-Kogan, Daphne A.
AU - Kreissman, Susan G.
AU - Khanna, Geetika
AU - Rosen, Nancy
AU - Park, Julie R.
AU - La Quaglia, Michael P.
N1 - Funding Information:
Supported by National Cancer Institute Grants No. U10 CA29139, U10 CA98413, and U10-CA098543 to the Children's Oncology Group; and National Institutes of Health Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center (M.P.L.).
Publisher Copyright:
© 2016 by American Society of Clinical Oncology.
PY - 2017/1/10
Y1 - 2017/1/10
N2 - Purpose This analysis of patients in the Children's Oncology Group A3973 study evaluated the impact of extent of primary tumor resection on local progression and survival and assessed concordance between clinical and central imaging review-based assessments of resection extent. Patients and Methods The analytic cohort (n = 220) included patients who had both central surgery review and resection of the primary tumor site. For this analysis, resection categories of, 90% and ≥ 90% were used, with data on resection extent derived from operating surgeons' assessments (all patients), as well as blinded central imaging review of computed tomography scans for a subset of 84 patients; assessment results were compared for concordance. Treatment outcomes included event-free survival (EFS), overall survival (OS), and cumulative incidence of local progression (CILP). Results Surgeon-assessed extent of resection was ≥ 90% in 154 (70%) patients and<90% in 66 (30%). Five-year EFS, OS, and CILP (± SE) were 43.5% ± 3.7%, 54.9% ± 3.7%, and 11.9% ± 2.2%, respectively. EFS was higher with ≥ 90% resection (45.9% ± 4.3%) than with<90% resection (37.9%±7.2%; P = .04). Lower CILP (P = .01) was associated with≥90% resection (8.5%±2.3%) compared with <90% resection (19.8% ± 5.0%). On multivariable analysis, ≥ 90% resection was associated with longer EFS after adjustment for MYCN amplification or diploidy but had no significant effect on OS. Concordance between surgeons' assessments of resection extent and central image-guided review was low, with agreement of 63% (<90% v ≥ 90%; simple κ = 20.0301). Conclusion Despite discordance between clinical assessment of resection extent and assessment via central imaging review, a surgeon-assessed resection extent ≥ 90% was associated with significantly better EFS and lower CILP. Improving OS, however, remains a challenge in this disease. These findings support continued attempts at ≥ 90% resection of the primary tumor in high-risk neuroblastoma.
AB - Purpose This analysis of patients in the Children's Oncology Group A3973 study evaluated the impact of extent of primary tumor resection on local progression and survival and assessed concordance between clinical and central imaging review-based assessments of resection extent. Patients and Methods The analytic cohort (n = 220) included patients who had both central surgery review and resection of the primary tumor site. For this analysis, resection categories of, 90% and ≥ 90% were used, with data on resection extent derived from operating surgeons' assessments (all patients), as well as blinded central imaging review of computed tomography scans for a subset of 84 patients; assessment results were compared for concordance. Treatment outcomes included event-free survival (EFS), overall survival (OS), and cumulative incidence of local progression (CILP). Results Surgeon-assessed extent of resection was ≥ 90% in 154 (70%) patients and<90% in 66 (30%). Five-year EFS, OS, and CILP (± SE) were 43.5% ± 3.7%, 54.9% ± 3.7%, and 11.9% ± 2.2%, respectively. EFS was higher with ≥ 90% resection (45.9% ± 4.3%) than with<90% resection (37.9%±7.2%; P = .04). Lower CILP (P = .01) was associated with≥90% resection (8.5%±2.3%) compared with <90% resection (19.8% ± 5.0%). On multivariable analysis, ≥ 90% resection was associated with longer EFS after adjustment for MYCN amplification or diploidy but had no significant effect on OS. Concordance between surgeons' assessments of resection extent and central image-guided review was low, with agreement of 63% (<90% v ≥ 90%; simple κ = 20.0301). Conclusion Despite discordance between clinical assessment of resection extent and assessment via central imaging review, a surgeon-assessed resection extent ≥ 90% was associated with significantly better EFS and lower CILP. Improving OS, however, remains a challenge in this disease. These findings support continued attempts at ≥ 90% resection of the primary tumor in high-risk neuroblastoma.
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U2 - 10.1200/JCO.2016.67.2642
DO - 10.1200/JCO.2016.67.2642
M3 - Article
C2 - 27870572
AN - SCOPUS:85009919356
SN - 0732-183X
VL - 35
SP - 208
EP - 216
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 2
ER -
