Impact of primary tumor resection on survival in high-risk neuroblastoma: a long-term single-center study

The prognostic value of primary tumor resection in high-risk neuroblastoma (HrNB) remains controversial. While several Western studies have suggested a survival benefit of complete resection, our institution has not observed a clear association. We therefore evaluated the long-term impact of surgical resection, particularly the extent of resection, in HrNB over four decades.

We retrospectively reviewed 64 consecutive patients with HrNB treated at our center between 1985 and 2023. Patients were classified into complete resection and incomplete/no resection groups. In the more recent cohort (2007-2023), outcomes were also compared between patients who underwent resection and those who did not. Overall survival (OS) and causes of death were analyzed.

Among 64 patients, 11 underwent no resection, 28 incomplete resection, and 25 complete resection. Five-year OS did not differ significantly between the complete and incomplete/no resection groups (57.4% vs. 53.0%). PBSCT-stratified analyses showed similar results. In the more recent cohort (n = 34), five-year OS was comparable between non-resection and resection groups (72.0% vs. 71.5%). A > 20% reduction in primary tumor diameter after induction chemotherapy was strongly associated with better survival.

Some HrNB patients can achieve favorable survival without surgical resection, supporting individualized surgical strategies and prospective multi-institutional validation.