Sandbox:prognosis

# 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.
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- The table below lists the prognostic factors for neuroblastoma patients:
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
 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; 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:
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:
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. ArrayCGH, FISH, or conventional cytogenetics cannot detect copy neutral LOH.

# Liber
Predictors of a poor prognosis:
High mitotic-karyorrhectic index.
Lack of schwannian stroma.
18 months.
Near ploidy.
N-MYC amplification.
Lymph node spread.
Distant spread.
-  Neuroblastoma. Radiopaedia(2015)  Accessed on October, 5 2015
-  Neuroblastoma. Wikipedia(2015)  Accessed on October, 5 2015
-   Neuroblastoma Treatment for health professionals. National Cancer Institute (2015) #link/_534_toc Accessed on October, 7 2015
-   Neuroblastoma. Libre Pathology(2015) #Neuroblastoma Accessed on October, 5 2015