Prognostic Risk Groups

Recently, a number of risk stratification systems have been developed for treatment stratification purposes. Of the vast number of markers that have been investigated for prognostic impact, only a few are clinically useful to determine risk and treatment strategies.Vir-tually all classification systems utilize INSS stage, age at the time of diagnosis, and the status of the MYCN gene to determine risk. The Children's Oncology Group (COG) Risk Group Classification System also includes tumor histology and DNA ploidy. In Germany the presence of clinically threatening symptoms and the degree of "resectability" of the primary tumor are also stratifying parameters. The various factors that are used to classify patients as low-, intermediate-, or high risk in different cooperative groups are shown in Table 7.8. Until a uniform classification system is established, it will remain difficult to compare results

Figure 7.4 a,b

Event-free survival (EFS) and overall survival (OS) in 951 patients according to risk categories. a EFS: Observation group n=433, 3-year-EFS 84.5±1.9%, Standard-risk group n=140, 3-year-EFS 74.6±4.3%, High-risk group n=378, 3-year-EFS 39.4±3.0%. b OS: Observation group n=433, 3-year-OS 97.3±0.8%, Standard-risk group n=140, 3-year-OS 91.7±2.6%, High-risk group n=378,3-year-OS 60.5±3.0%

Table 7.8. Synopsis of neuroblastoma risk definitions by major study groups

Study group

Risk factor INSS stage

Age (years)

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