title: Sacrococcygeal teratoma growth rate predicts adverse outcomes.
abstract: OBJECTIVE
  The purpose of this study was to characterize the growth rate of sacrococcygeal teratomas (SCTs) and determine its relationship to adverse outcomes.
  
  
  METHODS
  A retrospective review of all pathology-confirmed isolated SCT patients evaluated with at least two documented ultrasounds and followed through hospital discharge between 2005 and 2012 was conducted. SCT growth rate was calculated as the difference between tumor volumes on a late- and early-gestation ultrasound divided by the difference in time. Outcomes were death, high-output cardiac failure (HOCF), hydrops, and preterm delivery. Student's t-test, receiver operator characteristics, Fisher's Exact test, and Pearson's correlation were performed.
  
  
  RESULTS
  Of the 28 study subjects, there were 3 in utero demises and 2 neonatal deaths. Significantly faster SCT growth rates were seen in all adverse outcomes, including death (p<0.0001), HOCF (p=0.005), and preterm delivery (p=0.009). There was a significant association with adverse outcomes at >61cm(3)/week (AUC=0.87, p=0.001, LR=4.52). Furthermore, there was an even greater association with death at >165cm(3)/week (AUC=0.93, p=0.003, LR=18.42). Growth rate was directly correlated with the percent of solid tumor (r=0.60, p=0.0008).
  
  
  CONCLUSIONS
  Faster SCT growth is associated with adverse outcomes. SCT growth rate determined by ultrasound is an effective prognostic indicator for adverse outcomes and easily applied to patient management.
authors.affiliation: Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Coleman
authors.affiliation: Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA.
authors.forename: Aimen
authors.initials: A
authors.lastname: Shaaban
authors.affiliation: Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Keswani
authors.affiliation: Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA. Electronic address: foong.yen.lim@cchmc.org.
authors.forename: Foong-Yen
authors.initials: FY
authors.lastname: Lim
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000196:embryology / Q000401:mortality; D015996:Survival Rate / Q000639:trends; D013724:Teratoma / Q000175:diagnosis* / Q000196:embryology / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Adverse outcomes; Growth rate; Sacrococcygeal teratoma; Ultrasound