Annals of Oncology 7:183-187, 1996
© 1996 European Society for Medical Oncology
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The recurrence patterns of stages I, II and III neuroblastoma: Experience with 77 relapsing patients
1Children's Hospital of Koln University Germany
2Dortmund Community Hospital Germany
3Gieflen University Germany
9Hamburg University Germany
5Augsburg Community Hospital Germany
6St. Augustin Community Hospital Germany
7Tubingen University Germany
8Munchen Technical University Germany
9Hannover University Germany
Frank Berthold, M.D. Klinik und Poliklinik fur Kinderheilkunde der Universitat zu Koln Joseph-Stelzmann-StraBe 9 50924 Koln, Germany
Background: Recurrences of neuroblastoma Evans' stage I-III are infrequent events and the types of its progression have rarely been reported. Therefore, we investigated the patterns of progression in a large series of patients with long follow-up.
Patients and methods: The sites of relapse and time to progression and death of 381 consecutive patients in three cooperative trials (NB 79, 82, 85) with follow-up of 5–16 years were analysed. The Southern blot technique was used for N-myc investigation of tumor tissue.
Results: Of the 77 relapsing patients, 41 (53%) had local and 36 (47%) systemic recurrences. The relapses occurred in 9 of 76 stage I patients (6 local/3 systemic), in 4 of 82 stage II (1 local/3 systemic) and 64 of 223 stage III neuroblastoma (34 local/30 systemic) patients. The main sites of distant metastasis were bone marrow (41%), lymph nodes (39%) and bone (37%). The median transition time from localised to metastatic neuroblastoma was 13 months and the outcome as poor (overall survival 9 ± 5%) as that of the primary metastatic disease (14 ± 3%). Fifty-three children died of tumor progression and 15 patients of treatment-related complications or other non-tumor conditions.
The median age at diagnosis was 43 months for the group with systemic relapse compared to 19 months with only local and 10 months without recurrences (p < 0.001). Elevated serum LDH levels at first diagnosis were seen in 81% with metastatic, in 55% with local and in 33% with no tumor progression (p < 0.001). N-myc amplification was found in 4/14 with local and in 6/12 with metastatic recurrences.
Conclusion: The high incidence of systemic relapse and the long transition time suggest that transition from localised to metastatic neuroblastoma is not an uncommon pathway.
neuroblastoma, N-myc, recurrence, risk-factor, screening, transition
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