A retrospective study of coarse calcification as an independent risk factor for poor prognosis and early metastasis in paediatric neuroblastoma.
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OBJECTIVE: This study aims to investigate the connection between calcification features in CT images of pediatric neuroblastoma (NB) patients and their clinical-pathological characteristics, early distant metastasis, and survival prognosis, thereby revealing the potential significance of calcification in tumor progression and prognostic assessment. METHODS: We retrospectively collected data from 173 pediatric NB patients treated at Chongqing Medical University Children's Hospital. Calcifications were classified into three types based on CT imaging: no calcification, punctate calcification, and coarse calcification. We analyzed their associations with tumor size, histological subtype, INRG staging, risk group, MYCN amplification, and overall survival. Calcium, iron, and zinc levels were evaluated in calcified versus non-calcified areas of surgical specimens, and the calcification CT ratio (maximum calcification CT number divided by mean thoracic spine CT number) was calculated. RESULTS: Tumor diameter > 10 cm, INRG M stage, high-risk group, and MYCN amplification were all strongly linked with coarse calcification (all P < 0.05). Coarse calcification was an independent risk factor for early distant metastasis(OR = 27.839, P < 0.001). CT calcification numbers varied significantly between differentcalcification sub-types (P < 0.05). The concentrations of calcium, iron, and zinc varied considerably (P < 0.05) between calcified and non-calcified areas, and the size of calcification was correlated with iron concentration. The coarse calcification group's overall survival was significantly shorter than that of the non-calcification and punctate calcification groups, according to survival analysis (χ2 = 23.761, P < 0.001). CONCLUSION: Coarse calcification observed in CT imaging serves as a crucial prognostic indicator in pediatric neuroblastoma, closely linked to tumor aggressiveness, early distant metastasis, and decreased survival rates. This study advocates for the integration of calcification classification into neuroblastoma prognostic assessment systems and establishes a basis for future investigations into the molecular mechanisms related to calcification and potential targeted interventions.