Abstract
Lung metastases in patients with neuroblastoma (NB) are an extremely rare situation. Such patients have a worse prognosis and more aggressive clinical behavior of the underlying disease. This article presents an analysis of the epidemiological, clinical, radiologic features and prognosis of the disease in a group of patients with stage 4 NB and lung metastases. The cohort of NB patients with stage 4 according to the International Neuroblastoma Staging System (INSS) treated in NRC PHOI named after Dmitry Rogachev for the period 01.2012–12.2016 (60 months) was included in the analysis. Patients were stratified and treated according to the modified protocol NB-2004. Comparative analysis of patients with high-risk NB with and without lung metastases was done. Estimated event-free and overall survival were determined using Kaplan–Meier methods. Among 132 patients with stage 4 NB lung metastases were detected in 10 cases, which represented 7.5% of the whole group. The median age of the patients with lung metastases was 26.4 months (range 4.3–92.5). 9 (90%) patients were stratified to highrisk group, 1 (10%) to intermediate risk group. Comparative analysis of patients with stage 4 high-risk NB with and without lung metastases showed no statistical difference in comparison by sex, age, localization of the primary tumor, MYCN status, and the number of metastatic compartments. Progression during induction therapy was more frequent in patients with lung metastases (p = 0.02). 2-year overall survival (OS) in the group of patients with lung metastases was lower than in group without metastases to the lung (50.0 ± 15.8% vs 75.9 ± 3.9%, p = 0.045). In our study, the presence of lung metastases was more common than was described elsewhere and is clinically important because it portends a poor prognosis.
Highlights
ФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им
This article presents an analysis of the epidemiological, clinical, radiologic features and prognosis of the disease in a group of patients with stage 4 NB and lung metastases
The cohort of NB patients with stage 4 according to the International Neuroblastoma Staging System (INSS) treated in NRC PHOI named after Dmitry Rogachev for the period 01.2012–12.2016 (60 months) was included in the analysis
Summary
Контактная информация: Шаманская Татьяна Викторовна, ученый секретарь Института онкологии, радиологии и ядерной медицины НМИЦ детской гематологии, онкологии и иммунологии им. В статье представлен анализ эпидемиологических, клинических, визуализационных особенностей и прогноза заболевания в группе пациентов с 4-й стадией НБ и локализацией метастазов в легких, получавших лечение в НМИЦ ДГОИ им. Проведены сравнительный анализ пациентов высокой группы риска с метастазами в легкие и без них; оценка общей и бессобытийной выживаемости по методу Каплана–Мейера. Из 132 пациентов с 4-й стадией НБ в 10 (7,5%) случаях было выявлено метастатическое поражение легких При сравнительном анализе пациентов с 4-й стадией НБ высокой группы риска с метастазами в легкие и без них не было отмечено статистической разницы при сравнении по полу, возрасту, локализации первичной опухоли, статусу гена MYCN, количеству сайтов метастатического поражения. Статистически чаще у пациентов с метастазами в легких отмечали прогрессию заболевания на фоне индукционной терапии (р = 0,02). Ключевые слова: нейробластома, дети, метастатическое поражение легких, сцинтиграфия с 123I-метайодбензилгуанидином, компьютерная томография, выживаемость
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