Document Detail

The influence of biologic factors on the surgical decision in advanced neuroblastoma.
MedLine Citation:
PMID:  16418884     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Molecular markers greatly affect the outcome of neuroblastoma. This study evaluated the influence of Trk-A and myelocytomatosis viral-related oncogene, neuroblastoma-derived (MYCN) on the role of surgery in advanced neuroblastoma. METHODS: Ten stage 3 and 35 stage 4 neuroblastoma patients were included. Tumor resection was classified into gross total resection (GTR) and incomplete resection. Patients were classified into three biological risk groups according to Trk-A expression and myelocytomatosis viral-related oncogene, neuroblastoma-derived (MYCN) status in tumor tissues studied by immunohistochemistry and fluorescence in situ hybridization, respectively: low risk (positive Trk-A and normal MYCN), intermediate risk (negative Trk-A and normal MYCN), and high risk (positive or negative Trk-A and MYCN amplification). The effect of tumor resection on prognosis was studied and stratified according to the risk grouping. RESULTS: GTR was achieved in 21 patients (46.7%) with a higher complication rate (33% vs. 8% in the incomplete resection group, P = .036). GTR was easier to achieve in low-risk tumors than in intermediate- or high-risk tumors (12 of 13, 4 of 17, and 5 of 15, respectively; P < .001). GTR predicted a favorable prognosis for intermediate-risk patients (P = .037; log-rank test), but not for low- or high-risk patients because of the overall favorable and poor prognosis, respectively. CONCLUSIONS: GTR carries a potentially higher possibility of complication. Although GTR can be achieved easily in low-risk neuroblastoma patients with a favorable prognosis, surgeons should do their best to achieve GTR for intermediate-risk patients to improve outcome. Nevertheless, sacrificing vital organs to achieve GTR for high-risk patients is not justified.
Wen-Ming Hsu; Yung-Ming Jen; Hsinyu Lee; Min-Liang Kuo; Po-Nien Tsao; Chiung-Nien Chen; Dar-Ming Lai; Ming-Tsan Lin; Hong-Shiee Lai; Wei-Jao Chen; Fon-Jou Hsieh
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-01-18
Journal Detail:
Title:  Annals of surgical oncology     Volume:  13     ISSN:  1068-9265     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-30     Completed Date:  2006-05-11     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  238-44     Citation Subset:  IM    
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, #7 Chung-Shan South Road, Taipei 100, Taiwan.
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MeSH Terms
Child, Preschool
Decision Making*
Multivariate Analysis
Neuroblastoma / mortality,  pathology*,  surgery*
Nuclear Proteins / metabolism*
Oncogene Proteins / metabolism*
Proportional Hazards Models
Receptor, trkA / metabolism*
Risk Assessment
Survival Rate
Taiwan / epidemiology
Tumor Markers, Biological / metabolism*
Reg. No./Substance:
0/MYCN protein, human; 0/Nuclear Proteins; 0/Oncogene Proteins; 0/Tumor Markers, Biological; EC, trkA

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