Impact of extent of resection on survival in high-risk neuroblastoma: A systematic review and meta-analysis.
J Pediatr Surg
; 54(7): 1487-1494, 2019 Jul.
Article
en En
| MEDLINE
| ID: mdl-30262202
ABSTRACT
BACKGROUND:
Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients is still poor. Many studies designed to elaborate the association between the extent of resection (EOR) and outcome have reported conflicting results. We performed a meta-analysis to assess whether greater EOR is associated with improved overall survival (OS) and event-free survival (EFS) in patients with high-risk neuroblastoma.METHODS:
Embase, PubMed, Cochrane library, and conference proceedings were searched between March 10 and October 1, 2017. Studies of pediatric patients with newly diagnosed high-risk neuroblastoma comparing various EOR and presenting objective overall or event-free survival data were included. Primary outcomes were relative risk (RR) for mortality at 3 and 5â¯years. Secondary outcomes were 3-year and 5-year EFS rates.RESULTS:
19 retrospective studies including a total of 2358 cases were identified. Compared with subtotal resection (STR), patients who underwent gross total resection (GTR) had significantly decreased mortality at 3â¯years (RR, 0.69; 95% CI, 0.58-0.82; Pâ¯<â¯0.001; I2â¯=â¯27%) and 5â¯years (RR, 0.70; 95% CI, 0.60-0.82; Pâ¯<â¯0.001; I2â¯=â¯38%). A similar decrease was revealed in the 3-year risk for mortality for STR compared with biopsy (RR, 0.71; 95% CI, 0.53-0.95; Pâ¯=â¯0.02; I2â¯=â¯0%). When comparing any resection with biopsy, resection group also showed a decreased risk for mortality at 3â¯years (RR, 0.66; 95% CI, 0.53-0.83; Pâ¯<â¯0.001; I2â¯=â¯8%) and 5â¯years (RR, 0.67; 95% CI, 0.50-0.91; Pâ¯=â¯0.009; I2â¯=â¯61%). With respect to the risk ratio for EFS, there were no significant differences in any comparisons.CONCLUSION:
This literature highlights the importance of "extent of resection" in treating high-risk neuroblastoma, and when feasible, the currently available evidences in favor of the use of GTR for high-risk neuroblastoma for reducing 3- and 5-year mortality. LEVEL OF EVIDENCE 3A.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neuroblastoma
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
J Pediatr Surg
Año:
2019
Tipo del documento:
Article