title: A long duration of the prediagnostic symptomatic interval is not associated with an unfavourable prognosis in childhood medulloblastoma.
abstract: BACKGROUND
  Due to the lacking specificity of symptoms making a correct diagnosis can be a challenge in children with medulloblastoma. This can lead to prediagnostic symptomatic intervals (PSIs) of several weeks to months. It is unknown whether the length of the PSI is associated with an inferior survival outcome in this population.
  
  
  METHODS
  To study the association of PSI with disease stage at diagnosis, tumour control and survival in children with medulloblastoma, prospectively collected data on PSI, clinical, and biological features were analysed in 224 patients diagnosed at the age of 3-18 years and treated within the prospective randomised multicentre trial HIT'91.
  
  
  RESULTS
  Patients with lower-stage disease tended towards a longer median PSI than those with higher-stage disease (M0 stage, 2.0 months; M1 stage, 2.0 months; M2/M3 stage, 1 month; p = 0.094. M0/1 stage versus M2/3 stage; p = 0.025). The patient group with the longest PSI had the best survival outcome (PSI ≥ 4.0 months: 10-year overall survival rate (OS), 71%; PSI < 4.0 months, 10-year OS, 61%; p = 0.056). Age at diagnosis was positively correlated with PSI (p = 0.027). No associations were found between PSI and sex histological subtype, presence of postoperative residual tumour, or c-myc and TrkC mRNA expression.
  
  
  CONCLUSIONS
  Contrary to a common belief that a longer PSI may adversely affect prognosis, a longer PSI was associated with a trend towards lower metastatic stage and better survival probabilities. Nevertheless these findings do not obviate the importance of a timely diagnosis in paediatric patients with medulloblastoma.
authors.affiliation: Department of Oncology, University Children's Hospital, CH-8032 Zurich, Switzerland. nicolas.gerber@kispi.uzh.ch
authors.forename: Nicolas U
authors.initials: NU
authors.lastname: Gerber
authors.forename: Katja
authors.initials: K
authors.lastname: von Hoff
authors.forename: André O
authors.initials: AO
authors.lastname: von Bueren
authors.forename: Wiebke
authors.initials: W
authors.lastname: Treulieb
authors.forename: Frank
authors.initials: F
authors.lastname: Deinlein
authors.forename: Martin
authors.initials: M
authors.lastname: Benesch
authors.forename: Isabella
authors.initials: I
authors.lastname: Zwiener
authors.forename: Niels
authors.initials: N
authors.lastname: Soerensen
authors.forename: Monika
authors.initials: M
authors.lastname: Warmuth-Metz
authors.forename: Torsten
authors.initials: T
authors.lastname: Pietsch
authors.forename: Uwe
authors.initials: U
authors.lastname: Mittler
authors.forename: Joachim
authors.initials: J
authors.lastname: Kuehl
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grotzer
authors.forename: Stefan
authors.initials: S
authors.lastname: Rutkowski
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002528:Cerebellar Neoplasms / Q000175:diagnosis* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D013997:Time Factors