Neuroblastoma. Evaluation of 60 cases

Prognostic importance of DNA flow cytometrical, histopathological and immunohistochemical parameters in neuroblastomas

In 42 tumour samples of human neuroblastoma, histological classification by differentiation (Shimada) was significantly correlated with strong positivity for neuron-specific enolase (NSE) and inversely correlated with rosette formation. Most ganglioneuroblastomas were positive for S-100 protein and reacted strongly with NSE antibody. Histological signs of high proliferative activity included intermediate or high mitosis-karyorrhexis index, necrosis and lack of calcification, which were significantly correlated with each other. Flow cytometric DNA analysis demonstrated that 88% of the tumour samples had DNA aneuploid stem lines. High S phase fraction (greater than or equal to 0.20) was significantly correlated with necrosis and lack of calcification. Univariate analysis of prognosis for 26 patients whose tumour samples were obtained before adjuvant treatment showed that five factors were significantly related to a better outcome: early stage of the disease (stages I, II, IV-S), S phase fraction less than 0.20, favourable Shimada histology, positivity for S-100 protein, and strong positivity for NSE. In multivariate analysis, only S phase fraction or stage of disease remained significantly associated with prognosis. DNA index did not correlate with prognosis in this study.

Neonatal cancer in Denmark 1943-1985

In order to describe the incidence, distribution, and prognosis of neonatal cancer, 76 cases (44 boys, 32 girls) of cancer in the first 28 days of life were identified in the Danish Cancer Registry within the period 1943-1985. All cases were reevaluated and the International Classification of Disease for Oncology (ICD-O) code was applied. The incidence is calculated to 2.38 (1.88-2.98) cases per 100,000 births. The most common tumor was neuroblastoma (26%) followed by leukemias (16%), soft-tissue sarcomas (14%), and brain tumors (11%). The 5-year survival rate was 25% (15.1-39.0) with the highest survival rate among soft-tissue sarcomas (55%) and neuroblastomas (25%) and the lowest among leukemias and brain tumors (0). Eighteen percent of the cases were incidental findings. Two cases of secondary malignancy were identified.

Neonatal tumours: Glasgow 1955-86

Fifty one neonatal tumours were diagnosed in Glasgow over a 32 year period. The most common tumours were teratomas (n=19), others being renal tumours (n=9), soft tissue sarcomas (n=8), neuroblastomas (n=7), and others (n=8). Of the total, 31% were malignant. Neonatal tumours pose difficult problems of management, and because of their comparative rarity and the great potential for cure we recommend that all centres dealing with such patients should contribute to and benefit from a Neonatal Tumour Registry.

Complete pathologic maturation and regression of stage IVS neuroblastoma without treatment

Spontaneous maturation of Stage IVS neuroblastoma has been postulated as a mechanism for its favorable prognosis, but this has rarely been documented pathologically. We report on a patient with congenital Stage IVS neuroblastoma who had extensive subcutaneous and bone-marrow involvement. Serial photographs, biopsies, and vanillomandelic acid determinations documented the tumor's initial progression which was followed by spontaneous maturation and involution of the patient's disease over a 6-year period. No cytotoxic therapy was administered. Favorable biologic prognostic factors were documented, including tumor DNA and protein analyses for N-myc amplification or overexpression and analysis for serum neuron-specific enolase and ferritin. Implications for management and therapy of Stage IVS neuroblastoma are discussed with reference to this case and the recent literature.

Effects of the mass screening of neuroblastoma in Sapporo City

One hundred sixty-seven cases of neuroblastoma in the Registry of Childhood Malignancies in Hokkaido Prefecture from 1969 to 1984 were studied, using the age at diagnosis, the clinical stage at diagnosis, and the survival rate to assess the influence of the mass screening of neuroblastoma performed in Sapporo City since 1981. In Sapporo City, the capital of Hokkaido Prefecture, the condition of the three parameters improved significantly after the institution of mass screening (e.g., the 48-month survival rate improved--from 21.3% to 87.5%). In Hokkaido Prefecture (Sapporo City excluded), however, where the mass screening had not yet been performed, no significant change was observed in any of the three parameters (48-month survival rate changed only from 21.1% to 28.1%). Consequently, the improvement in Sapporo City was thought to be attributable to the effects of the mass screening.

Neuroblastomas treated at the four major child oncologic clinics in Denmark 1943-1980: an evaluation of 180 cases

One hundred and eighty cases of neuroblastomas from the four child oncology clinics are reviewed. The overall cure rate was 24%. During the 38-year period, there was a significant increase in survival from 0% during the period of 1943-1950 to 32% during the period of 1971-1980. This improved survival rate is most likely a result of adjuvant chemotherapy. Forty percent of the patients appear chronically ill, which reflects the fact that nearly 60% have metastases when they are first seen. In localized disease (stages I-II), the prognosis was favourable (cure rate 69%), while the prognosis for disseminated disease (stage III-IV) was poor (cure rate 5%). A favourable outcome was seen in patients under 1 year (survival rate 46%), and in patients with primary tumours located in the neck or mediastinum (survival rate 48%). When related to stage, however, the survival rates for the former tumours were not significantly better in patients below 1 year or in patients with cervical or thoracic tumours. As is the case in other studies, we found that survival is significantly poorer in males.

Neuroblastoma. Mass screening for early detection and its prognosis

Since July 1973, the authors began developing a mass screening system using a VMA (vanilmandelic acid) spot test on 6-to-7 month-old infants for early detection of neuroblastoma in Kyoto city, Japan. Using this method, six infants with this tumor were discovered; five of the six infants were cured, and one is under treatment. These patients showed a favorable prognosis on early diagnosis. In this article, 57 neuroblastoma patients from the Department of Pediatrics, Kyoto Prefectural University of Medicine, treated during the last 20 years, from July 1962 to June 1982, are evaluated. Since the mass screening program has run smoothly since July 1974, clinical findings are compared between 35 neuroblastoma cases before mass screening from the 12-year period from July 1962 to June 1974 and 22 cases after mass screening, during the 8-year period from July 1974 to June 1982. Before mass screening, only 20% (7/35) of the patients were discovered with neuroblastoma younger than 12 months of age and 68.6% were older than 2 years of age. After mass screening, 54.6% (12/22) of the patients were younger than 12 months of age and only 31.8% (7/22) were older than 2 years of age. Before mass screening, 17.1% (6/35) survived with five of the six surviving patients being younger than 12 months of age at the time of diagnosis; 72.7% (16/22) of the patients detected after mass screening are living now. Eleven of the 16 patients have already been cured, and the remaining 5 patients are presently undergoing treatment. A marked improvement of their prognoses is dependent on the early detection of this tumor by mass screening. To date, using the VMA spot test for early detection in infancy is convenient and effective for improvement of its prognosis.