手术在神经母细胞瘤治疗中的作用
The Role of Surgery in the Treatment of Neuroblastoma
DOI: 10.12677/acm.2026.1641333, PDF,   
作者: 曾 秒, 章 均*：重庆医科大学附属儿童医院肿瘤外科，儿童少年健康与疾病国家临床研究中心，儿童发育疾病研究教育部重点实验室，重庆；重庆市卫生健康委儿童器官发育与疾病重点实验室，重庆
关键词: 神经母细胞瘤；手术；手术切除范围；手术时机；预后；Neuroblastoma； Surgery； Scope of Surgical Resection； Timing of Surgery； Prognosis
摘要: 神经母细胞瘤是儿童最常见的颅外实体恶性肿瘤，占所有儿童肿瘤的8%~10%。高危患者的预后仍然很差，目前高危患儿的长期生存率 < 50%。高危神经母细胞瘤的最佳局部控制是通过手术切除和原发肿瘤的外部放射治疗相结合实现的。关于神经母细胞瘤患儿的手术切除范围、手术时机对预后的影响仍然存在争议，本综述通过评价已发表的回顾性和前瞻性研究，尝试回答这些争议，以阐明手术切除在高风险神经母细胞瘤患者治疗中的作用及其对总体预后的影响。
Abstract: Neuroblastoma is the most common extracranial solid malignant tumor in children, accounting for 8%~10% of all childhood tumors. The prognosis for high-risk patients remains poor, with the current long-term survival rate for high-risk children being less than 50%. The best local control for high-risk neuroblastoma is achieved through a combination of surgical resection and external radiotherapy to the primary tumor. There is still controversy regarding the impact of the extent of surgical resection and the timing of surgery on prognosis. This review attempts to address these controversies by evaluating published retrospective and prospective studies, in order to clarify the role of surgical resection in the treatment of high-risk neuroblastoma patients and its impact on overall prognosis.
文章引用：曾秒, 章均. 手术在神经母细胞瘤治疗中的作用[J]. 临床医学进展, 2026, 16(4): 1013-1020. https://doi.org/10.12677/acm.2026.1641333

参考文献

[1] Qiu, B. and Matthay, K.K. (2022) Advancing Therapy for Neuroblastoma. Nature Reviews Clinical Oncology, 19, 515-533. [Google Scholar] [CrossRef] [PubMed]
[2] Matthay, K.K., Maris, J.M., Schleiermacher, G., Nakagawara, A., Mackall, C.L., Diller, L., et al. (2016) Neuroblastoma. Nature Reviews Disease Primers, 2, Article No. 16078. [Google Scholar] [CrossRef] [PubMed]
[3] Wienke, J., Dierselhuis, M.P., Tytgat, G.A.M., Künkele, A., Nierkens, S. and Molenaar, J.J. (2021) The Immune Landscape of Neuroblastoma: Challenges and Opportunities for Novel Therapeutic Strategies in Pediatric Oncology. European Journal of Cancer, 144, 123-150. [Google Scholar] [CrossRef] [PubMed]
[4] Zhou, X., Wang, X., Li, N., Guo, Y., Yang, X. and Lei, Y. (2023) Therapy Resistance in Neuroblastoma: Mechanisms and Reversal Strategies. Frontiers in Pharmacology, 14, Article ID: 1114295. [Google Scholar] [CrossRef] [PubMed]
[5] Irwin, M.S. and Park, J.R. (2015) Neuroblastoma: Paradigm for Precision Medicine. Pediatric Clinics of North America, 62, 225-256. [Google Scholar] [CrossRef] [PubMed]
[6] Park, J.R., Eggert, A. and Caron, H. (2008) Neuroblastoma: Biology, Prognosis, and Treatment. Pediatric Clinics of North America, 55, 97-120. [Google Scholar] [CrossRef] [PubMed]
[7] Yu, A.L., Gilman, A.L., Ozkaynak, M.F., London, W.B., Kreissman, S.G., Chen, H.X., et al. (2010) Anti-GD2 Antibody with GM-CSF, Interleukin-2, and Isotretinoin for Neuroblastoma. New England Journal of Medicine, 363, 1324-1334. [Google Scholar] [CrossRef] [PubMed]
[8] Ahmed, G., Fawzy, M., Elmenawi, S., Elzomor, H., Yosif, Y., Elkinaai, N., et al. (2018) Role of Surgery in Localized Initially Unresectable Neuroblastoma. Journal of Pediatric Urology, 14, 231-236. [Google Scholar] [CrossRef] [PubMed]
[9] Ryan, A.L., Akinkuotu, A., Pierro, A., Morgenstern, D.A. and Irwin, M.S. (2020) The Role of Surgery in High-Risk Neuroblastoma. Journal of Pediatric Hematology/Oncology, 42, 1-7. [Google Scholar] [CrossRef] [PubMed]
[10] Tolbert, V.P. and Matthay, K.K. (2018) Neuroblastoma: Clinical and Biological Approach to Risk Stratification and Treatment. Cell and Tissue Research, 372, 195-209. [Google Scholar] [CrossRef] [PubMed]
[11] Li, Q., Wang, J., Cheng, Y., Hu, A., Li, D., Wang, X., et al. (2023) Long-Term Survival of Neuroblastoma Patients Receiving Surgery, Chemotherapy, and Radiotherapy: A Propensity Score Matching Study. Journal of Clinical Medicine, 12, Article 754. [Google Scholar] [CrossRef] [PubMed]
[12] Bansal, D., Totadri, S., Chinnaswamy, G., Agarwala, S., Vora, T., Arora, B., et al. (2017) Management of Neuroblastoma: ICMR Consensus Document. The Indian Journal of Pediatrics, 84, 446-455. [Google Scholar] [CrossRef] [PubMed]
[13] Strother, D.R., London, W.B., Schmidt, M.L., et al. (2012) Outcome after Surgery Alone or with Restricted Use of Chemotherapy for Patients with Low-Risk Neuroblastoma: Results of Children’s Oncology Group Study P9641. Yearbook of Oncology, 2012, 217-218. [Google Scholar] [CrossRef] 
[14] Yang, X., Chen, J., Wang, N., Liu, Z., Li, F., Zhou, J., et al. (2019) Impact of Extent of Resection on Survival in High-Risk Neuroblastoma: A Systematic Review and Meta-Analysis. Journal of Pediatric Surgery, 54, 1487-1494. [Google Scholar] [CrossRef] [PubMed]
[15] Zwaveling, S., Tytgat, G.A.M., van der Zee, D.C., Wijnen, M.H.W.A. and Heij, H.A. (2012) Is Complete Surgical Resection of Stage 4 Neuroblastoma a Prerequisite for Optimal Survival or May >95 % Tumour Resection Suffice? Pediatric Surgery International, 28, 953-959. [Google Scholar] [CrossRef] [PubMed]
[16] Mullassery, D., Farrelly, P. and Losty, P.D. (2014) Does Aggressive Surgical Resection Improve Survival in Advanced Stage 3 and 4 Neuroblastoma? A Systematic Review and Meta-Analysis. Pediatric Hematology and Oncology, 31, 703-716. [Google Scholar] [CrossRef] [PubMed]
[17] Du, L., Liu, L., Zhang, C., Cai, W., Wu, Y., Wang, J., et al. (2014) Role of Surgery in the Treatment of Patients with High-Risk Neuroblastoma Who Have a Poor Response to Induction Chemotherapy. Journal of Pediatric Surgery, 49, 528-533. [Google Scholar] [CrossRef] [PubMed]
[18] Englum, B.R., Rialon, K.L., Speicher, P.J., Gulack, B., Driscoll, T.A., Kreissman, S.G., et al. (2015) Value of Surgical Resection in Children with High‐Risk Neuroblastoma. Pediatric Blood & Cancer, 62, 1529-1535. [Google Scholar] [CrossRef] [PubMed]
[19] Vollmer, K., Gfroerer, S., Theilen, T., Bochennek, K., Klingebiel, T., Rolle, U., et al. (2018) Radical Surgery Improves Survival in Patients with Stage 4 Neuroblastoma. World Journal of Surgery, 42, 1877-1884. [Google Scholar] [CrossRef] [PubMed]
[20] Adkins, E.S., Sawin, R., Gerbing, R.B., London, W.B., Matthay, K.K. and Haase, G.M. (2004) Efficacy of Complete Resection for High-Risk Neuroblastoma: A Children’s Cancer Group Study. Journal of Pediatric Surgery, 39, 931-936. [Google Scholar] [CrossRef] [PubMed]
[21] La Quaglia, M.P., Kushner, B.H., Su, W., Heller, G., Kramer, K., Abramson, S., et al. (2004) The Impact of Gross Total Resection on Local Control and Survival in High-Risk Neuroblastoma. Journal of Pediatric Surgery, 39, 412-417. [Google Scholar] [CrossRef] [PubMed]
[22] Fischer, J., Pohl, A., Volland, R., Hero, B., Dübbers, M., Cernaianu, G., et al. (2017) Complete Surgical Resection Improves Outcome in INRG High-Risk Patients with Localized Neuroblastoma Older than 18 Months. BMC Cancer, 17, Article No. 520. [Google Scholar] [CrossRef] [PubMed]
[23] Holmes, K., Pötschger, U., Pearson, A.D.J., Sarnacki, S., Cecchetto, G., Gomez-Chacon, J., et al. (2020) Influence of Surgical Excision on the Survival of Patients with Stage 4 High-Risk Neuroblastoma: A Report from the HR-NBL1/SIOPEN Study. Journal of Clinical Oncology, 38, 2902-2915. [Google Scholar] [CrossRef] [PubMed]
[24] Tsuchida, Y., Yokoyama, J., Kaneko, M., Uchino, J., Iwafuchi, M., Makino, S., et al. (1992) Therapeutic Significance of Surgery in Advanced Neuroblastoma: A Report from the Study Group of Japan. Journal of Pediatric Surgery, 27, 616-622. [Google Scholar] [CrossRef] [PubMed]
[25] Iehara, T., Yoneda, A., Yokota, I., Takahashi, H., Teramukai, S., Kamijyo, T., et al. (2019) Results of a Prospective Clinical Trial JN‐L‐10 Using Image‐Defined Risk Factors to Inform Surgical Decisions for Children with Low‐Risk Neuroblastoma Disease: A Report from the Japan Children’s Cancer Group Neuroblastoma Committee. Pediatric Blood & Cancer, 66, e27914. [Google Scholar] [CrossRef] [PubMed]
[26] Uehara, S., Yoneda, A., Oue, T., Nakahata, K., Zenitani, M., Miyamura, T., et al. (2017) Role of Surgery in Delayed Local Treatment for INSS 4 Neuroblastoma. Pediatrics International, 59, 986-990. [Google Scholar] [CrossRef] [PubMed]
[27] Simon, T., Häberle, B., Hero, B., von Schweinitz, D. and Berthold, F. (2013) Role of Surgery in the Treatment of Patients with Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis. Journal of Clinical Oncology, 31, 752-758. [Google Scholar] [CrossRef] [PubMed]
[28] von Allmen, D., Davidoff, A.M., London, W.B., Van Ryn, C., Haas-Kogan, D.A., Kreissman, S.G., et al. (2017) Impact of Extent of Resection on Local Control and Survival in Patients from the COG A3973 Study with High-Risk Neuroblastoma. Journal of Clinical Oncology, 35, 208-216. [Google Scholar] [CrossRef] [PubMed]
[29] Yanishevski, D., McCarville, M.B., Doubrovin, M., Spiegl, H.R., Zhao, X., Lu, Z., et al. (2020) Impact of MYCN Status on Response of High-Risk Neuroblastoma to Neoadjuvant Chemotherapy. Journal of Pediatric Surgery, 55, 130-134. [Google Scholar] [CrossRef] [PubMed]
[30] Irtan, S., Brisse, H.J., Minard‐Colin, V., Schleiermacher, G., Galmiche‐Rolland, L., Le Cossec, C., et al. (2015) Image‐defined Risk Factor Assessment of Neurogenic Tumors after Neoadjuvant Chemotherapy Is Useful for Predicting Intra‐operative Risk Factors and the Completeness of Resection. Pediatric Blood & Cancer, 62, 1543-1549. [Google Scholar] [CrossRef] [PubMed]
[31] Bagatell, R., McHugh, K., Naranjo, A., Van Ryn, C., Kirby, C., Brock, P., et al. (2016) Assessment of Primary Site Response in Children with High-Risk Neuroblastoma: An International Multicenter Study. Journal of Clinical Oncology, 34, 740-746. [Google Scholar] [CrossRef] [PubMed]
[32] Pohl, A., Erichsen, M., Stehr, M., Hubertus, J., Bergmann, F., Kammer, B., et al. (2016) Image-Defined Risk Factors Correlate with Surgical Radicality and Local Recurrence in Patients with Neuroblastoma. Klinische Pädiatrie, 228, 118-123. [Google Scholar] [CrossRef] [PubMed]
[33] Cecchetto, G., Mosseri, V., De Bernardi, B., Helardot, P., Monclair, T., Costa, E., et al. (2005) Surgical Risk Factors in Primary Surgery for Localized Neuroblastoma: The LNESG1 Study of the European International Society of Pediatric Oncology Neuroblastoma Group. Journal of Clinical Oncology, 23, 8483-8489. [Google Scholar] [CrossRef] [PubMed]
[34] 陈吉, 姜斌, 易军, 等. 影像学危险因子分期法在胸腹部局限性神经母细胞瘤手术风险评估中的运用[J]. 中华小儿外科杂志, 2019, 40(8): 678-682.
[35] Zhang, A., Pan, C., Xu, M., Wang, X., Ye, Q., Gao, Y., et al. (2019) Association of Image-Defined Risk Factors, Tumor Resectability, and Prognosis in Children with Localized Neuroblastoma. World Journal of Pediatrics, 15, 572-579. [Google Scholar] [CrossRef] [PubMed]
[36] Medary, I., Aronson, D., Cheung, N.V., Ghavimi, F., Gerald, W. and La Quaglia, M.P. (1996) Kinetics of Primary Tumor Regression with Chemotherapy: Implications for the Timing of Surgery. Annals of Surgical Oncology, 3, 521-525. [Google Scholar] [CrossRef] [PubMed]
[37] Children’s Oncology Group (2018) A Phase 3 Study of 131I-Metaiodobenzylguanidine (131I-MIBG) or Crizotinib Added to Intensive Therapy for Children with Newly Diagnosed High-Risk Neuroblastoma (NBL).
[38] Hashii, Y., Kusafuka, T., Ohta, H., Yoneda, A., Osugi, Y., Kobayashi, Y., et al. (2008) A Case Series of Children with High-Risk Metastatic Neuroblastoma Treated with a Novel Treatment Strategy Consisting of Postponed Primary Surgery Until the End of Systemic Chemotherapy Including High-Dose Chemotherapy. Pediatric Hematology and Oncology, 25, 439-450. [Google Scholar] [CrossRef] [PubMed]
[39] Yoneda, A. (2023) Role of Surgery in Neuroblastoma. Pediatric Surgery International, 39, Article No. 177. [Google Scholar] [CrossRef] [PubMed]

为你推荐