Universität zu Köln

Morgenstern, Daniel A., London, Wendy B., Stephens, Derek, Volchenboum, Samuel L., Hero, Barbara, Di Cataldo, Andrea ORCID: 0000-0002-4509-3066, Nakagawara, Akira, Shimada, Hiroyuki, Ambros, Peter F., Matthay, Katherine K., Cohn, Susan L., Pearson, Andrew D. J. and Irwin, Meredith S. (2014). Metastatic Neuroblastoma Confined to Distant Lymph Nodes (stage 4N) Predicts Outcome in Patients With Stage 4 Disease: A Study From the International Neuroblastoma Risk Group Database. J. Clin. Oncol., 32 (12). S. 1228 - 1240. ALEXANDRIA: AMER SOC CLINICAL ONCOLOGY. ISSN 1527-7755

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Abstract

Purpose The presence of distant metastases is one of the most powerful predictors of outcome in patients with neuroblastoma. However, the pattern of metastatic spread is not incorporated into current risk stratification systems. Small case series have suggested that patients with neuroblastoma who have metastatic disease limited to distant lymph nodes (4N disease) may have improved outcomes. Patients and Methods We analyzed retrospective data from the International Neuroblastoma Risk Group database for patients diagnosed from 1990 to 2002. 4N patients were compared with the remaining stage 4 patients (non-4N), excluding those with missing metastatic site data. Results In all, 2,250 International Neuroblastoma Staging System stage 4 patients with complete data were identified, of whom 146 (6.5%) had 4N disease. For 4N patients, event-free survival (EFS; 5-year, 77% 4%) and overall survival (OS; 5-year, 85% +/- 3%) were significantly better than EFS (5-year, 35% +/- 1%) and OS (5-year, 42% +/- 1%) for non-4N stage 4 patients (P < .001). 4N patients were more likely to be younger (P < .001) and have tumors with favorable characteristics, including absence of MYCN amplification (89% v 69%; P < .001). In a multivariable analysis, 4N disease remained a significant predictor of outcome (hazard ratio for non-4N v 4N: 3.40 for EFS and 3.69 for OS). Within subgroups defined by age at diagnosis and tumor MYCN status, 4N disease was significantly associated with improved outcomes. Conclusion 4N represents a subgroup with better outcome than that of other patients with metastatic disease. These findings suggest that the biology and treatment response of 4N tumors differ from other stage 4 tumors, and less intensive therapy should be considered for this cohort. Future exploration of biologic factors determining the pattern of metastatic spread is warranted.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Morgenstern, Daniel A. UNSPECIFIED UNSPECIFIED UNSPECIFIED London, Wendy B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stephens, Derek UNSPECIFIED UNSPECIFIED UNSPECIFIED Volchenboum, Samuel L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hero, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED Di Cataldo, Andrea UNSPECIFIED orcid.org/0000-0002-4509-3066 UNSPECIFIED Nakagawara, Akira UNSPECIFIED UNSPECIFIED UNSPECIFIED Shimada, Hiroyuki UNSPECIFIED UNSPECIFIED UNSPECIFIED Ambros, Peter F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Matthay, Katherine K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cohn, Susan L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pearson, Andrew D. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Irwin, Meredith S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-440577
DOI:	10.1200/JCO.2013.53.6342
Journal or Publication Title:	J. Clin. Oncol.
Volume:	32
Number:	12
Page Range:	S. 1228 - 1240
Date:	2014
Publisher:	AMER SOC CLINICAL ONCOLOGY
Place of Publication:	ALEXANDRIA
ISSN:	1527-7755
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PATHOLOGY CLASSIFICATION; ONCOLOGY-GROUP; N-MYC; IV-N; AGE; AMPLIFICATION; DIAGNOSIS; CHILDREN; CANCER; SYSTEM Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44057