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

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