Sandbox:prognosis: Difference between revisions

Revision as of 15:31, 11 October 2015

Overview

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis of neuroblastoma is generally regarded as poor.

The table below lists the prognostic factors for neuroblastoma development:

Prognostic Factor	Description
Patients Age	Patients older than 18 months of age are associated with poor prognosis
Tumor Stage	Advanced INSS stages of neuroblastoma are associated with poor prognosis
Tumor Grade	An unfavorable Shimada histology index is associated with poor prognosis
Schwannnian Stroma	A reduced schwannian stroma background content on histological analysis is associated with poor prognosis
Mitotic-karyorrhectic Index	A high mitotic-karyorrhectic index is associated with poor prognosis
Genetics Mutations	Chromosome 1p deletion, chromosome 11q deletion, and N-MYC oncogene amplification are associated with poor prognosis
Response to Treatment	Patients whose neuroblastoma responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment

Patients Age Patients older than 18 months of age are associated with poor prognosis Tumor Stage Advanced INSS stages of neuroblastoma are associated with poor prognosis Tumor Grade An unfavorable Shimada histology index is associated with poor prognosis Schwannnian Stroma A reduced schwannian stroma background content on histological analysis is associated with poor prognosis Mitotic-karyorrhectic Index A high mitotic-karyorrhectic index is associated with poor prognosis Genetics Mutations Chromosome 1p deletion, chromosome 11q deletion, and N-MYC oncogene amplification are associated with poor prognosis Response to Treatment Patients whose neuroblastoma responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment

Radiopedia

stage 1, 2 or 4S: 75-90% 3 year survival stage 3 <1 year of age: 80-90% 1 year event free survival >1 year of age: 50% 3 year survival

stage 4 <1 year of age: 60-75% 1 year event free survival >1 year of age: 15% 3 year survival

Between 1975 and 2010, the 5-year survival rate for neuroblastoma in the United States increased from 86% to 95% for children younger than 1 year and increased from 34% to 68% for children aged 1 to 14 years.

Goverment

[1] The 5-year overall survival (OS) for all infants and children with neuroblastoma has increased from 46% when diagnosed between 1974 and 1989, to 71% when diagnosed between 1999 and 2005;[48] however, this single number can be misleading because of the extremely heterogeneous prognosis based on the neuroblastoma patient's age, stage, and biology. (Refer to Table 1 for more information.) Approximately 70% of patients with neuroblastoma have metastatic disease at diagnosis.

Wikipedia

Prognosis

Cytogenetic profiles

Based on a series of 493 neuroblastoma samples, it has been reported that overall genomic pattern, as tested by array-based karyotyping, is a predictor of outcome in neuroblastoma:[58]

Tumors presenting exclusively with whole chromosome copy number changes were associated with excellent survival. Tumors presenting with any kind of segmental chromosome copy number changes were associated with a high risk of relapse. Within tumors showing segmental alterations, additional independent predictors of decreased overall survival were N-myc amplification, 1p and 11q deletions, and 1q gain.

Earlier publications categorized neuroblastomas into three major subtypes based on cytogenetic profiles:[59][60]

Subtype 1: favorable neuroblastoma with near triploidy and a predominance of numerical gains and losses, mostly representing non-metastatic NB stages 1, 2 and 4S. Subtypes 2A and 2B: found in unfavorable widespread neuroblastoma, stages 3 and 4, with 11q loss and 17q gain without N-myc amplification (subtype 2A) or with N-myc amplification often together with 1p deletions and 17q gain (subtype 2B).

Virtual karyotyping can be performed on fresh or paraffin-embedded tumors to assess copy number at these loci. SNP array virtual karyotyping is preferred for tumor samples, including neuroblastomas, because they can detect copy neutral loss of heterozygosity (acquired uniparental disomy). Copy neutral LOH can be biologically equivalent to a deletion and has been detected at key loci in neuroblastoma.[61] ArrayCGH, FISH, or conventional cytogenetics cannot detect copy neutral LOH.

Liber

Predictors of a poor prognosis:[16]

High mitotic-karyorrhectic index. Lack of schwannian stroma. >18 months. Near ploidy. N-MYC amplification. Lymph node spread. Distant spread.

@@ Line 1: / Line 1: @@
-==Radiopedia==
+==Overview==
+Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis of neuroblastoma is generally regarded as poor.
+*The table below lists the prognostic factors for neuroblastoma development:
+{|
+! style="background: #4479BA; width: 200px; color: #FFFFFF;"|'''Prognostic Factor'''
+! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Patients Age'''|| style="padding: 5px 5px; background: #F5F5F5;" |Patients older than 18 months of age are associated with poor prognosis
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Tumor Stage'''|| style="padding: 5px 5px; background: #F5F5F5;" |Advanced INSS stages of neuroblastoma are associated with poor prognosis
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Tumor Grade'''|| style="padding: 5px 5px; background: #F5F5F5;" |An unfavorable Shimada histology index is associated with poor prognosis
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Schwannnian Stroma'''|| style="padding: 5px 5px; background: #F5F5F5;" |
+A reduced schwannian stroma background content on histological analysis is associated with poor prognosis
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Mitotic-karyorrhectic Index'''|| style="padding: 5px 5px; background: #F5F5F5;" |A high mitotic-karyorrhectic index is associated with poor prognosis
+|-
-Treatment and prognosis
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Genetics Mutations'''|| style="padding: 5px 5px; background: #F5F5F5;" |Chromosome 1p deletion, chromosome 11q deletion, and N-MYC oncogene amplification are associated with poor prognosis
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Response to Treatment'''|| style="padding: 5px 5px; background: #F5F5F5;" |Patients whose neuroblastoma responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment
+|}
-Treatment depends on the patients stage. Localised tumours considered to be 'low-risk' are surgically excised and patients tend to do very well (see below). In 'high-risk' tumours, a combination or surgery, chemotherapy +/- bone marrow transplantation is employed, unfortunately with poor overall results. In some cases, where tumours are very large, pre-surgical chemotherapy to attempt to down-stage the tumour may be administered 2.
+Patients Age Patients older than 18 months of age are associated with poor prognosis
+Tumor Stage Advanced INSS stages of neuroblastoma are associated with poor prognosis
+Tumor Grade An unfavorable Shimada histology index is associated with poor prognosis
+Schwannnian Stroma A reduced schwannian stroma background content on histological analysis is associated with poor prognosis
+Mitotic-karyorrhectic Index A high mitotic-karyorrhectic index is associated with poor prognosis
+Genetics Mutations Chromosome 1p deletion, chromosome 11q deletion, and N-MYC oncogene amplification are associated with poor prognosis
+Response to Treatment Patients whose neuroblastoma responds to treatment and goes into complete remission have a better prognosis than people whose cancer does not respond to the initial treatment
-Patients with stage 1, 2 or 4S have a better prognosis. Unfortunately 40-60% of patients present with stage 3 or 4 disease 4. For advanced disease, the age of the child is most important 3.
+==Radiopedia==
 stage 1, 2 or 4S: 75-90% 3 year survival
 stage 3
@@ Line 16: / Line 53: @@
 >1 year of age: 15% 3 year survival
-Poor prognostic factors
+Between 1975 and 2010, the 5-year survival rate for neuroblastoma in the United States increased from 86% to 95% for children younger than 1 year and increased from 34% to 68% for children aged 1 to 14 years.
-N-Myc mutation
-chromosome 1p deletion
-unfavourable Shimada histology index
-later age of onset
 ==Goverment==
-Between 1975 and 2010, the 5-year survival rate for neuroblastoma in the United States increased from 86% to 95% for children younger than 1 year and increased from 34% to 68% for children aged 1 to 14 years.[1] The 5-year overall survival (OS) for all infants and children with neuroblastoma has increased from 46% when diagnosed between 1974 and 1989, to 71% when diagnosed between 1999 and 2005;[48] however, this single number can be misleading because of the extremely heterogeneous prognosis based on the neuroblastoma patient's age, stage, and biology. (Refer to Table 1 for more information.) Approximately 70% of patients with neuroblastoma have metastatic disease at diagnosis.
+[1] The 5-year overall survival (OS) for all infants and children with neuroblastoma has increased from 46% when diagnosed between 1974 and 1989, to 71% when diagnosed between 1999 and 2005;[48] however, this single number can be misleading because of the extremely heterogeneous prognosis based on the neuroblastoma patient's age, stage, and biology. (Refer to Table 1 for more information.) Approximately 70% of patients with neuroblastoma have metastatic disease at diagnosis.
-The prognosis for patients with neuroblastoma is related to the following:[49-52]
-Age at diagnosis.
-Site of the primary tumor.
-Tumor histology.
-Regional lymph node involvement (in children older than 1 year, but this is controversial).
-Response to treatment.
-Biological features.
-Some of these prognostic factors have been combined to create risk groups to help define treatment. (Refer to the International Neuroblastoma Risk Group Staging System section and the Children’s Oncology Group Neuroblastoma Risk Grouping section of this summary for more information.)
 ==Wikipedia==
 Prognosis
-Between 20% and 50% of high-risk cases do not respond adequately to induction high-dose chemotherapy and are progressive or refractory.[50][51] Relapse after completion of frontline therapy is also common. Further treatment is available in phase I and phase II clinical trials that test new agents and combinations of agents against neuroblastoma, but the outcome remains very poor for relapsed high-risk disease.[52]
-Most long-term survivors alive today had low or intermediate risk disease and milder courses of treatment compared to high-risk disease. The majority of survivors have long-term effects from the treatment. Survivors of intermediate and high-risk treatment often experience hearing loss. Growth reduction, thyroid function disorders, learning difficulties, and greater risk of secondary cancers affect survivors of high-risk disease.[53][54] An estimated two of three survivors of childhood cancer will ultimately develop at least one chronic and sometimes life-threatening health problem within 20 to 30 years after the cancer diagnosis.[55][56][57]
 Cytogenetic profiles