Successful treatment of stage III neuroblastoma based on prospective biologic staging: a Children's Cancer Group study
| Autor: | James B. Atkinson, H. Shimada, Katherine K. Matthay, Robert B. Gerbing, Daniel O. Stram, Gerald M. Haase, C T Black, Seeger Rc, Patrick S. Swift, Carlos A. Perez, John N. Lukens, Garrett M. Brodeur |
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| Rok vydání: | 1998 |
| Předmět: |
Male
Oncology Cancer Research medicine.medical_specialty Multimodality Therapy Disease-Free Survival Neuroblastoma Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Life Tables Prospective Studies Stage (cooking) Prospective cohort study Bone Marrow Transplantation Stage III Neuroblastoma Group study business.industry Infant Cancer Prognosis medicine.disease Combined Modality Therapy Surgery El Niño Child Preschool Ferritins Female business |
| Zdroj: | Journal of Clinical Oncology. 16:1256-1264 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.1998.16.4.1256 |
| Popis: | PURPOSE To identify a biologically favorable and unfavorable subset of patients with Evans stage III neuroblastoma and to determine whether treatment stratification would improve the event-free survival (EFS) for high-risk patients and maintain excellent EFS for the lower-risk patients. PATIENTS AND METHODS Risk stratification was performed by age, MYCN gene copy number, Shimada histopathologic classification, and serum ferritin level. Lower-risk patients were treated on the less intensive Children's Cancer Group (CCG)-3881, whereas high-risk patients were treated on CCG-3891, which included more intensive multimodality therapy and, in some cases, autologous bone marrow transplantation (ABMT). RESULTS Of 228 Evans stage III patients entered onto the study, 92% also met the definition of International Neuroblastoma Staging System (INSS) stage 3. One hundred forty-three patients met the lower-risk criteria, which included 89 patients less than 1 year of age and 54 patients 1 year of age or greater, and favorable biology, whereas 85 patients were 1 year of age or greater and biologically unfavorable. Biologically unfavorable patients 1 year of age or greater who underwent gross surgical resection had improved survival, whereas the outcome of infants or biologically favorable older patients did not change according to resection. The EFS rate at 4 years was 100% for the patients with favorable biology of any age, 90% for those less than 1 year of age but with at least one unfavorable characteristic, and 54% for Evans stage III patients 1 year of age or greater with unfavorable biology. Age, ferritin level, MYCN copy number, Shimada histopathology, primary site, and intraspinal extension were significant univariate prognostic factors for all patients, but only MYCN copy number and age were independent factors in multivariate analyses. CONCLUSION The excellent survival of the biologically favorable group and the historically improved EFS of the biologically unfavorable group suggest that biologic staging should be used to define the prognosis and treatment of stage III neuroblastoma. |
| Databáze: | OpenAIRE |
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