Preoperative Cytopenia in Patients Affected by High-Risk Neuroblastoma: Just a Matter of Platelets?

In patients affected by high-risk neuroblastoma (HR-NB), complete macroscopic resection (CMR) is associated with better outcomes. These patients are often cytopenic due to intensive induction regimens. The aim of the present study is to assess the impact of preoperative cytopenia on surgical outcome in patients with HR-NB.

A chart review of patients with HR-NB operated on after neoadjuvant chemotherapy between January 2013 and July 2024 was conducted. Cytopenia was defined by full blood count values in the 24 h before surgery. Two primary outcomes were analyzed: the rate of CMR and the incidence of postoperative complications. Secondary outcomes were postoperative length of stay (LOS) and red blood cell transfusion requirement.

Sixty-eight patients underwent surgical removal of the primary tumor after induction chemotherapy. Thirty-seven patients (54%) were cytopenic immediately before surgery; 17 patients had anemia (25%), 20 had thrombocytopenia (29%; 16 patients with platelets between 100 × 10³/µL and 50 × 10³/µL, four patients with platelets less than 50 × 10³/µL), and six had neutropenia (9%). Patients with platelets less than 50 × 10³/µL had a significantly higher postoperative complications rate (75% vs. 22%, p = 0.046) and increased median LOS [12.5 days (7-31) vs. 7 days (3-43), p = 0.040], but comparable CMR rate and perioperative RBC transfusion volumes. Anemia, neutropenia, and platelets between 100 × 10³/µL and 50 × 10³/µL had no impact on outcomes.

Anemia, neutropenia, and platelets between 100 × 10³/µL and 50 × 10³/µL are not contraindications to elective major surgery in patients with HR-NB. The risk of surgical complications in patients with platelets less than 50 × 10³/µL has to be balanced against the risk of long delay in surgical treatment.