Clinical Features of Children with Retinoblastoma and Neuroblastoma

Prognostic Values of Primary Tumor Textural Heterogeneity and Blood Biomarkers in High-risk Neuroblastoma

PURPOSE

The aim of this study was to evaluate the prognostic value of textural parameters of primary tumors, serum lactate dehydrogenase (LDH), D -dimer, and ferritin in high-risk neuroblastoma patients.

PATIENTS AND METHODS

The imaging findings of 22 neuroblastoma patients (14 girls and 8 boys; age, 36.6 ± 34.2 [range: 5 to 138] months) who underwent 18-fluorodeoxyglucose positron emission tomography/computed tomography for primary staging before therapy between 2009 and 2020 were retrospectively evaluated. Positron emission tomography-derived metabolic data (maximum standard uptake value, mean standard uptake value, metabolic tumor volume, and total lesion glycolysis) and textural features of primary tumors were obtained. Serum LDH, D -dimer, and ferritin levels at the time of diagnosis were recorded. Univariate and multivariate Cox proportional hazards regression models were used to identify predictors for progression-free survival (PFS) and overall survival (OS). Survival curves were estimated by using the Kaplan-Meier method.

RESULTS

The median follow-up duration after diagnosis was 63 months (range: 5 to 141 mo). The median PFS and OS in all patients were 19 and 72 months, respectively. In multivariate Cox regression analyses with backward stepwise selection, grey level size zone matrix_size zone emphasis (GLSZM_SZE) was found as an independent predictor for both PFS and OS. Serum ferritin level was also found as an independent predictor for PFS. The Kaplan-Meier survival analysis showed that higher serum LDH, D -dimer, GLSZM_SZE, and zone size nonuniformity were significantly associated with shorter OS.

CONCLUSION

Serum LDH, D -dimer, ferritin levels, and GLSZM_SZE of primary tumors may be used as prognostic biomarkers to identify patients with worse prognoses in high-risk neuroblastoma. GLSZM textural features showing higher tumor heterogeneity are significantly associated with shorter PFS and OS.

A Study of Factors Influencing Delayed Diagnosis in Pediatric Cancers: A Step Towards Better Outcomes-A Cross-sectional Study

Annually, India contributes to one-fifth of newly diagnosed pediatric cancers worldwide. Poor outcome in India as compared with developed nations is mainly attributed to delayed diagnosis and study of factors influencing delay in diagnosis holds paramount importance in formulating strategies and counter-measures to improve survival. It was a cross-sectional study conducted on children diagnosed with malignancy at a tertiary care hospital. Diagnosis delay was defined and further divided into patient delay and physician delay. Various patient-related factors and socioeconomic factors that could affect diagnosis were studied. Statistical analysis included descriptive analysis, Mann-Whitney U test, Kruskal-Wallis test, and multivariate linear regression. Of 185 patients enrolled, median diagnosis delay, patient delay, and physician delays were 59, 30, and 7 days respectively. Median diagnosis delay was significantly higher in younger children, children of illiterate parents, and low income. Median diagnosis delay in children presenting to a general practitioner (9 [4 to 29] days) was higher than those presenting to a pediatrician (5.5 [2 to 18] days). Sex, occupation of parents, and distance from oncology center did not affect time for diagnosis. We concluded that augmentation of the parent's attitudes, increased awareness, and decentralization of specialized pediatric care to rural areas can significantly reduce mortality from, otherwise, curable malignancies.

The clinical diagnostic value of plasma miR-592 and miR-217-3p levels in retinoblastoma

BACKGROUND

This study was designed to investigate the abnormal expression of plasma miR-592 and miR-217-3p in retinoblastoma (Rb) and explore the clinical diagnostic value of their expression levels for Rb.

METHODS

The 100 Rb patients who came to Nanchang Hongdu Hospital of Traditional Chinese Medicine from January 2018 to January 2019 were selected as the Rb group, and 100 healthy patients who came to the physical examination centre during the same period were selected as the control group. Real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the expression levels of plasma miR-592 and miR-217-3p in all subjects; analyse the relationship between plasma miR-592 and miR-217-3p levels and the clinicopathological characteristics of Rb. Pearson correlation analysis evaluated the relationship between plasma miR-592 and miR-217-3p levels and overall survival.

RESULTS

Plasma levels of miR-592 and miR-217-3p in the Rb group were significantly higher than those in the control group (p<0.0001), and the expression of miR-592 was significantly correlated with family genetic history (p 0.0001), tumour bias (p=0.0081), lymph node metastasis (p=0.0048) and pathological grade (p=0.0025), and the expression of miR-217-3p was significantly related to family genetic history (p 0.0001), optic nerve infiltration (p 0.0001), lymph node metastasis (p=0.0090), and pathological grade (p 0.0001). The high expression of miR-592 and miR-217-3p presents a more serious pathological manifestation of Rb, and the overall survival of patients is significantly shortened with the increase of miR-592 (r=-0.2276, p=0.0052) and miR-217-3p levels (r=-0.6461, p 0.0001).

CONCLUSIONS

and miR-217-3p are highly expressed in the plasma of Rb patients, and their elevated levels present severe pathological manifestations of Rb and shortened overall survival, which is expected to become biomarkers for clinical diagnosis of Rb.

Retinoblastoma: A review of clinical profile at a regional cancer center in Northwest India

Background

Retinoblastoma is the most common primary intraocular malignancy of childhood. The present study was undertaken to overcome the scarcity of data regarding the epidemiology, demographic and clinical profile, and nature of the first health-care professional consulted.

Materials and Methods

A retrospective analysis of medical records was performed for all cases of retinoblastoma who presented to the department of ophthalmology and oncology between 2010 and 2017. A total of 54 cases were reviewed.

Results

Unilateral disease was seen in 85.2% while 14.8% presented with bilateral disease with a median age of 3 years and 2 years, respectively, at diagnosis. The male: female ratio was 2:1. The most common presenting symptom was leukocoria which was noticed in 42 patients (77.7%), followed by red eye (33.3%) and proptosis (20.3%). The most common stage of presentation was Stage I (44.4%), followed by Stage IV (20.4%), Stage III (9.3%), and Stage II (5.6%). The median time to diagnosis was 8.7 months (range, 0.5-98.7 months), and the median time to treatment was 37.4 days (range, 0-645 days). Majority of the patients were referred by local ophthalmologists (48%), followed by general practitioners (20%), nurses (19%), and quacks (13%). Enucleation was the most preferred treatment modality (48.1%), followed by chemotherapy (33.3%), radiotherapy (13%), photocoagulation (3.7%), and exenteration (1.9%). The overall remission rate was 79.6%, while 12.3% had relapse and 7.4% died.

Conclusion

The study showed a dire need for timely detection and treatment of retinoblastoma which is possible with improved awareness and better accessibility to health-care facilities. It also revealed a decrease in histopathological risk factors with chemoreduction.

Paediatric neuroblastoma presenting as an asymptomatic abdominal mass: a report on the importance of a complete clinical examination with a view to a timely diagnosis and therapeutic guidance in paediatric oncology

Neuroblastoma (NB) is the most common extracranial solid tumour in children after lymphoblastic leukaemias, brain tumours and lymphomas.We report a case of an NB in a previously healthy toddler. Though she had no abdominal complaints, on physical examination, she had a palpable mass identified over the right upper portion of the abdomen. Imaging studies demonstrated a heterogeneous tumour with an irregular capsule and visible calcifications.After initial diagnosis, the patient underwent chemotherapy and was subjected to a radical resection of the tumour 4 months later. One-year follow-up of the patient showed no recurrence.In children, oncological diseases are often asymptomatic or have non-specific symptoms, and in remote locations where specialised/paediatric services may not be available, the importance of medical training in paediatrics is highlighted, with emphasis on performing a complete clinical examination, namely abdominal palpation. The role of timely referral will be evident in such a situation.