Association of image‐defined risk factors with clinical features, histopathology, and outcomes in neuroblastoma

Temple, William C; Vo, Kieuhoa T.; Matthay, Katherine K.; Balliu, Brunilda; Coleman, Christina; Michlitsch, Jennifer; Phelps, Andrew; Behr, Spencer C.; Zapala, Matthew A.

doi:10.1002/cam4.3663

Cited by 30 publications

(34 citation statements)

References 33 publications

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“…More innovative approaches need to be discovered. 17 Therefore, identifying this subpopulation as early as possible would allow us to direct experimental therapies. In our study, 17 cases were considered to be ultra high‐risk among the 146 high‐risk patients, accounting for 11.6%.…”

Section: Discussionmentioning

confidence: 99%

MYCN amplification plus 1p36 loss of heterozygosity predicts ultra high risk in bone marrow metastatic neuroblastoma

et al. 2022

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Background This study aimed to better understand the prognostic effect of multiple genetic markers and identify more subpopulations at ultra high risk of poor outcome in bone marrow (BM) metastatic neuroblastoma (NB). Methods We screened the MYCN, 1p36 and 11q23 loss of heterozygosity (LOH) statuses of 154 patients by interphase fluorescence in situ hybridization of BM cells. The clinical characteristics of patients with the three markers and their associations with prognosis were analysed. Results MYCN amplification and LOH at 1p36 and 11q23 were identified in 16.2%, 33.1% and 30.5% of patients, respectively. There were strong associations between MYCN amplification and 1p36 LOH as well as 11q23 LOH. Both MYCN amplification and 1p36 LOH were strongly associated with high levels of lactate dehydrogenase (LDH) and neuron‐specific enolase, more than 3 metastatic organs, and more events. 11q23 LOH occurred mainly in patients older than 18 months, and those who had high LDH levels. In univariate analysis, patients with MYCN amplification had poorer prognosis than those without. Patients with 1p36 LOH had a 3‐year event‐free survival (EFS) and overall survival lower than those without. 11q23 LOH was associated with poorer EFS only for patients without MYCN amplification. In a multivariate model, MYCN amplification was independently associated with decreased EFS in all cohorts. 11q23 LOH was an independent prognostic factor for patients without MYCN amplification, whereas 1p36 LOH was not an independent marker regardless of MYCN amplification. Compared with all cohorts, patients with both MYCN amplification and 1p36 LOH had the worst outcome and clinical features. Conclusions Patients with both MYCN amplification and 1p36LOH had the worst survival rate, indicating an ultra high‐risk group. Our results may be applied in clinical practice for accurate risk stratification in future studies.

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Section: Discussionmentioning

confidence: 99%

MYCN amplification plus 1p36 loss of heterozygosity predicts ultra high risk in bone marrow metastatic neuroblastoma

et al. 2022

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“…Some authors have reported cases of successful emergency surgery on the primary mass in patients with ruptured neuroblastoma ( 7 , 13 ); in our case series, all the patients with hemorrhagic complications presented with encasement of the aorta and its major branches, that is a well-documented risk factor for major surgical complications and incomplete resection ( 28 – 30 ). In this scenario, emergency surgery on the primary mass should be reserved to patients who do not respond to other therapeutic measures.…”

Section: Discussionmentioning

confidence: 74%

“…Neuroblastoma patients with hemorrhagic complications need multimodal treatment that should be focused at controlling and limiting the bleeding while supporting vital functions, consisting in blood products administration, crystalloid and colloid infusion, surgical drain of hemothorax and angiographic control of the bleeding source. Some authors have reported cases of successful emergency surgery on the primary mass in patients with ruptured neuroblastoma (7,13); in our case series, all the patients with hemorrhagic complications presented with encasement of the aorta and its major branches, that is a well-documented risk factor for major surgical complications and incomplete resection (28)(29)(30). In this scenario, emergency surgery on the primary mass should be reserved to patients who do not respond to other therapeutic measures.…”

Section: Discussionmentioning

confidence: 84%

Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients

et al. 2021

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Background: Neuroblastoma is the most common solid extracranial tumor in children. Patients affected by neuroblastoma are stratified into low, intermediate, and high risk in terms of event-free and overall survival. Some high-risk patients have an additional risk of acute hemorrhagic complications during induction chemotherapy.Aim: To find easily and rapidly assessed parameters that help clinicians identify those patients affected by high-risk neuroblastoma who have an additional risk of hemorrhagic complications.Methods: The clinical notes of patients diagnosed with high-risk neuroblastoma from January 2013 until February 2021 were retrospectively reviewed. Clinical, demographic and laboratory data, biological characteristics of the tumor, and information about treatment and hospital stay were identified.Results: In the examined period, 44 patients were diagnosed with high-risk neuroblastoma. Four of these patients had hemorrhagic complications within 2–7 days after the initiation of induction chemotherapy; two patients had hemothorax, one patient had hemoperitoneum and one patient had hemothorax and hemoperitoneum. The patient with isolated hemoperitoneum was treated with blood components transfusions, clotting factors and colloids infusions; the three patients with hemothorax underwent thoracostomy tube placement and respiratory support. At initial presentation, patients who suffered from hemorrhagic complications had a higher degree of hypertension (stage 2, p = 0.0003), higher levels of LDH (median 3,745 U/L, p = 0.009) and lower levels of hemoglobin (mean 7.6 gr/dl, p = 0.0007) compared to other high-risk patients.Conclusions: A subgroup of “additional” high-risk patients can be identified within the high-risk neuroblastoma patients based on mean arterial pressure, LDH levels and hemoglobin levels at presentation. Further studies to define cut-off values and optimal management strategies for these patients are needed.

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“…Temple and colleagues provided an alternative way to stratify neuroblastoma according to risk with comparison of image-defined risk factors with molecular and histopathologic features. 10 Utilising established databases for the evaluation of these associations may lead to development of clinical strategies. A further translation, based on diagnostic resources available in limited resource settings, can be done.…”

Section: Application Of Expertise Diagnostics and Clinical Acumenmentioning

confidence: 99%

“…Risk stratification during diagnosis has become the benchmark for treatment in childhood malignancies, but often incorporates advanced biological testing in the stratification. Temple and colleagues provided an alternative way to stratify neuroblastoma according to risk with comparison of image‐defined risk factors with molecular and histopathologic features 10 . Utilising established databases for the evaluation of these associations may lead to development of clinical strategies.…”

Section: Application Of Expertise Diagnostics and Clinical Acumenmentioning

confidence: 99%

The need for resource‐linked translational oncology in the management of neuroblastoma and other childhood malignancies in low‐ and middle‐income countries

Heerden

Kruger

2021

Pediatric Blood & Cancer

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Association of image‐defined risk factors with clinical features, histopathology, and outcomes in neuroblastoma

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 30 publications

References 33 publications

MYCN amplification plus 1p36 loss of heterozygosity predicts ultra high risk in bone marrow metastatic neuroblastoma

MYCN amplification plus 1p36 loss of heterozygosity predicts ultra high risk in bone marrow metastatic neuroblastoma

Hemorrhage During Induction Chemotherapy in Neuroblastoma: Additional Risk Factors in High-Risk Patients

The need for resource‐linked translational oncology in the management of neuroblastoma and other childhood malignancies in low‐ and middle‐income countries

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