title: Tumor metrics and morphology predict poor prognosis in prenatally diagnosed sacrococcygeal teratoma: a 25-year experience at a single institution.
abstract: OBJECTIVE
  Some fetuses with sacrococcygeal teratoma (SCT) develop hydrops, but there is no consensus on an appropriate prognostic marker for poor prognosis. The purpose of this study is to establish predictors of poor prognosis in fetuses with SCT.
  
  
  METHODS
  A retrospective review of patients with prenatally diagnosed SCT from 1986 to 2011 was performed. Patients with outcome data and ultrasound exams before 32 weeks gestational age (GA) were included (n=37). Tumor volume-to-fetal weight ratio (TFR) and tumor morphology were assessed as sonographic predictors of poor prognosis.
  
  
  RESULTS
  Twelve patients (32%) had good prognosis, and twenty-five patients (68%) had poor prognosis. All patients with poor prognosis had a morphology score ≥ 3, which is a significant predictor of poor prognosis (p <0.0001). TFR was assessed, and a receiver operating characteristic (ROC) analysis identified a cutoff value of 0.12 before 24 weeks GA and 0.11 before 32 weeks GA as predictors for poor prognosis. TFR is a significant predictor of poor prognosis (p<0.0001).
  
  
  CONCLUSIONS
  Patients with cystic SCT all had good prognosis. TFR >0.12 was validated as a sonographic predictor of poor prognosis. TFR and tumor morphology can be used to counsel expectant families with prenatally diagnosed SCT regarding prognosis.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Eveline
authors.initials: E
authors.lastname: Shue
authors.forename: Marjan
authors.initials: M
authors.lastname: Bolouri
authors.forename: Eric B
authors.initials: EB
authors.lastname: Jelin
authors.forename: Lan
authors.initials: L
authors.lastname: Vu
authors.forename: Barbara
authors.initials: B
authors.lastname: Bratton
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cedars
authors.forename: Leah
authors.initials: L
authors.lastname: Yoke
authors.forename: Francesca
authors.initials: F
authors.lastname: Byrne
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.forename: Vickie
authors.initials: V
authors.lastname: Feldstein
authors.forename: Doug
authors.initials: D
authors.lastname: Miniati
authors.forename: Hanmin
authors.initials: H
authors.lastname: Lee
mesh_terms: D005260:Female; D047109:Fetal Development; D005500:Follow-Up Studies; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology; D007231:Infant, Newborn; D011247:Pregnancy; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D015996:Survival Rate; D013724:Teratoma / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D047368:Tumor Burden; D016216:Ultrasonography, Prenatal
keywords: Hydrops; SCT; Sacrococcygeal teratoma; TFR; Tumor morphology