The role of image-defined risk factors in surgical treatment planning of cervical neuroblastoma

Neuroblastoma is the third most common malignancy in children; however, cervical localization of this tumor occurs in no more than 10% of all NB cases, which makes the analysis of data of this patients’ cohort particularly challenging.
Objective. The aim of our study was to determine the correlation between the image-defined risk factors (IDRF) identified by computed tomography and magnetic resonance imaging and the results of the surgical treatment of cervical neuroblastoma.
Material and methods. This retrospective, single-center study includes the archival medical records of 30 patients aged from 0 to 18 years who underwent surgical treatment for cervical and cervicomediastinal neuroblastoma at the Dm. Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology between January 2012 and June 2025, with the assessment of the preoperative examination results along with the intra- and postoperative course. The obtained data were analyzed and compared with data published in the international literature.
Results. IDRFs were detected in 80% of patients; of these, 33% had 1 risk factor, nearly 42% had 2 factors, and 25% had more than 2 factors. All patients without RFs detected during the preoperative stage, as well as all patients with one RF, underwent gross total resection of the tumor. Macroscopically complete tumor resection was achieved in only 80% of patients with two risk factors and in 30% of patients with more than two risk factors. The obtained results allowed us to conclude that an increase in the number of risk factors based on the preoperative examination results negatively affects the surgical outcomes, prolongs the operating time by 34%, increases blood loss by 5.5 times, and raises the rate of postoperative complications by 3.4 times. The influence of individual groups of risk factors on the results requires further study.
Conclusion. The unique experience of surgical treatment of cervical NBs accumulated over 13 years allows us to evaluate our results and compare them with the limited data available in the literature, noting similarities with global findings.
Keywords: neuroblastoma, cervical localization, cervicomediastinal localization, image-defined risk factors, soft tissue neck masses
Conflict of interest. The authors declare no conflict of interest.
Financing. This study received no external funding.