The Significance Of Multiple Biomarkers For The Early Diagnosis And Prognosis Of Neuroblastoma In Children

Background:Neuroblastoma(NB)is the most common solid extracranial peripheral nervous system malignancy in children and newborns.Neuroblastoma has complex clinical manifestations,complicated disease progression,early non-specific clinical manifestations,easy to be misdiagnosed,and missed diagnosised.The pathogenesis of neuroblastoma is still unclear.Many studies have found that many factors of neuroblastoma are closely related to the diagnosis and prognosis of neuroblastoma.For example:age,sex,tumor metastasis site,pathological typing,treatment degree,and other factors related to chromosomal abnormalities,gene mutation.Objective:In order to probe the pathogenesis of neuroblastoma and to find new methods and indicators for better early diagnosis,prognosis evaluation and treatment,202 cases of neuroblastoma in pediatric internal medicine,pediatric surgery,neurology,neurosurgery,oncology,radiotherapy,chemotherapy and pathology were selected from September 2001 to December 2017.A retrospective study was conducted on the clinical manifestations,clinical stages,risk grouping,bone marrow metastasis,pathological classification and treatment of neuroblastoma in children.The tumor markers and gene mutations were further detected for a more suitable diagnosis for NB to evaluate the prognosis and improve the survival rate.Methods1 Research objects and data From September 2001 to December 2017,202 cases of neuroblastoma in pediatric internal medicine,pediatric surgery,neurology,neurosurgery,oncology,radiotherapy,chemotherapy and pathology were retrospectively studied.The clinical manifestations,clinical stages,risk groups and so on were analyzed.The clinical data of myeloid metastasis,pathological classification and treatment were analyzed comprehensively.The general data,clinical manifestations,clinical stages,disease grading,bone marrow metastasis,histopathological classification and comprehensive treatment of 202 children were recorded and summarized by consulting medical records and contacting parents of the children to collect examination reports.Diagnostic criteria,INSS staging,grading,typing and other criteria were included in accordance with international standards.The survival rates of 1 years,3 years and 5 years were followed up.2 Test methods Radioimmunoassay,electrochemiluminescence,FISH and PCR were used to detect tumor markers,chromosomes and genes.Results1 The prognosis of NB was influenced by age,pathological classification,location of tumor metastasis and degree of treatment.2 The amplification of MYCN gene and complete resection of bone marrow metastases are independent prognostic factors.3 SF>150mg/L,LDH>1500IU/L,NSE>100 mu g/L showed poor prognosis.Combined detection of serum LDH,VMA,CEA,NSE,SF and other tumor markers can provide important laboratory basis for clinical staging,curative effect evaluation and recurrence of neuroblastoma.4 Gene abnormalities and their proteomic manifestations are new indicators for diagnosis and prognosis of NB.Conclusions1 NB occurs mostly in preschool children,mainly in males,and tumors occur in the retroperitoneum.2 Complete resection of tumor,amplification of MYCN gene and bone marrow metastasis are independent prognostic factors.Surgical resection plays an important role in the treatment of NB.Complete resection of tumor is beneficial to prolong the survival time of prognosis.3 Combined detection of serum LDH,VMA,CEA,NSE,SF and other tumor markers can provide an important laboratory basis for clinical staging,efficacy evaluation and recurrence of neuroblastoma.4 The age of diagnosis,Shimada typing,MYCN gene,bone marrow cytology(and/or bone marrow biopsy)are of great significance for clinical staging,typing,risk grouping and evaluating prognosis.5 The copy number of N-myc gene is closely related to tumor growth and poor prognosis.6 Overexpression of ALK?ROS1?SPHK1?Nm23?PHOX2B?ATRX proteins are associated with NB high stage,low differentiation,malignant proliferation of tumor cells and poor prognosis.7 The combined detection and analysis of multiple gene mutations and proteomics components is helpful to determine the prognosis of NB.Novelty and significanceThrough retrospective follow-up,the clinical features and laboratory examinations of 201 children with neuroblastoma from 2001 to 2017 were summarized,including tumor markers,chromosomal abnormalities,gene mutations,proteomics and other indicators,to further explore the new basis for early diagnosis and treatment of NB:1.The combination of multiple tumor markers can improve the accuracy of early diagnosis and evaluation of NB.2 Various proteomic components are expected to be the basis for a new comprehensive evaluation of NB prognosis,quality of life.Limitation of this studyA The collection of cases involves many hospitals,and the time span is large.Different hospitals and laboratories have different test kits and normal range,which makes the later data analysis more difficult and may increase the uncertainty.B Proteomics is a relatively new detection item.At present,the number of samples is insufficient,which may lead to incorrect conclusions.It is necessary to further expand the number of samples to increase accuracy.