Trial reportJournal of clinical oncology : official journal of the American Society of Clinical Oncology2014
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.
Trial report in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 36 citations in OpenAlex.
- Uptake Patterns of Peripheral Ganglia onEuropean journal of nuclear medicine and molecular imaging · 2026Article
- International neuroblastoma risk group consortium: a model of networking for rare cancers.Journal of the National Cancer Institute · 2026Article
- Extracting Electronic Health Record Neuroblastoma Treatment Data With High Fidelity Using the REDCap Clinical Data Interoperability Services Module.JCO clinical cancer informatics · 2024Article
- Management of High-Risk Neuroblastoma with Soft-Tissue-Only Disease in the Era of Anti-GD2 Immunotherapy.Cancers · 2024Article
- Narrative review: precision medicine applications in neuroblastoma-current status and future prospects.Translational pediatrics · 2024Review
- Stage 4N neuroblastoma before and during the era of anti-GInternational journal of cancer · 2023Article
- Predicting MYCN amplification in paediatric neuroblastoma: development and validation of a 18F-FDG PET/CT-based radiomics signature.Insights into imaging · 2023Article
- A nomogram for the preoperative estimation of neuroblastoma risk despite inadequate biopsy information.Pediatric surgery international · 2023Article
- Long-Term Survival of Neuroblastoma Patients Receiving Surgery, Chemotherapy, and Radiotherapy: A Propensity Score Matching Study.Journal of clinical medicine · 2023Article
- Vitamin D Receptor Activation Attenuates Hippo Pathway Effectors and Cell Survival in Metastatic Neuroblastoma.Molecular cancer research : MCR · 2022Article
- Prediction of MYCN Amplification, 1p and 11q Aberrations in Pediatric NeuroblastomaFrontiers in medicine · 2022Article
- Tailoring Therapy for Children With Neuroblastoma on the Basis of Risk Group Classification: Past, Present, and Future.JCO clinical cancer informatics · 2020Review
- Ganglioneuroblastoma in children.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2019Article
- Neuroblastoma-A Neural Crest Derived Embryonal Malignancy.Frontiers in molecular neuroscience · 2019Review
- Lymph node imaging of pediatric renal and suprarenal malignancies.Translational andrology and urology · 2018Review
- Too many targets, not enough patients: rethinking neuroblastoma clinical trials.Nature reviews. Cancer · 2018Review
- Clinical evaluation of integrated panel testing by next-generation sequencing for somatic mutations in neuroblastomas with MYCN unamplification.Oncotarget · 2017Article
- Clinical and biological features of neuroblastic tumors: A comparison of neuroblastoma and ganglioneuroblastoma.Oncotarget · 2017Article
- Orbital Metastasis Is Associated With Decreased Survival in Stage M Neuroblastoma.Pediatric blood & cancer · 2016Article
- Article
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Authors and funding
13 authors at 1 institution in 1 country.
Funding
Abstract
purposeThe 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
methodsWe 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.
resultsIn 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.
conclusion4N 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.
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