Influence of local-regional lymph node metastases on prognosis in neuroblastoma

Data relative to the prognostic and therapeutic significance of lymph node metastases in regionally confined neuroblastoma (Evans stages II-III) are scant. We have analyzed lymph node status in order to assess the significance of nodal involvement. Disease-free survival (minimum follow-up of 2 years) was 84% (21/25) among node-positive patients compared with 95% (18/19) for node-negative patients (P greater than 0.1, two-tailed test). These results contrast with the results from two other centers in which lymph node involvement was a significant adverse prognostic indicator. The use of intensive multimodal therapy including surgical resection of the primary tumor, wide-field radiation therapy to the tumor bed and regional lymph nodes, and chemotherapy may have accounted for the better survival in our node-positive patients.