title: Predictors of poor prognosis in prenatally diagnosed sacrococcygeal teratoma: A multiinstitutional review.
abstract: BACKGROUND
  Attempts at defining predictors of poor outcome in fetal sacrococcygeal teratoma (SCT) have been hampered by small patient numbers. We sought to validate the utility of tumor volume to fetal weight ratio (TFR) as a predictor of poor prognosis and to identify other morphological outcome predictors in a multicenter series.
  
  
  METHODS
  Records of prenatally diagnosed SCT at three fetal centers from 1986 to 2011 were reviewed. Prenatal imaging characteristics including TFR, morphology, hydrops, and placentomegaly were assessed. Poor prognosis was defined as fetal demise, need for fetal intervention, or perinatal death. Receiver operating characteristic (ROC) analysis was used to select a TFR cutoff value.
  
  
  RESULTS
  Seventy-nine fetuses with SCT were evaluated. Eleven pregnancies ending in elective termination were excluded. ROC analysis revealed that TFR >0.12 prior to 24 weeks gestation was predictive of poor prognosis (AUC=0.913; Sensitivity=91.7%, Specificity=76.2%, PPV=86.8%; NPV=84.2%). Solid tumor morphology and presence of hydrops were found to be predictors of poor prognosis. None of the factors associated with poor prognosis were independent predictors on multivariate analysis.
  
  
  CONCLUSIONS
  This study validates TFR >0.12 prior to 24 weeks gestation as an objective predictor of outcomes in fetuses with SCT that can be easily applied in most clinical settings.
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Adesola C
authors.initials: AC
authors.lastname: Akinkuotu
authors.affiliation: Department of Pediatric Surgery, Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Coleman
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.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Fariha
authors.initials: F
authors.lastname: Sheikh
authors.affiliation: Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Hirose
authors.affiliation: Department of Pediatric Surgery, Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Foong-Yen
authors.initials: FY
authors.lastname: Lim
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA. Electronic address: oolutoye@bcm.edu.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
mesh_terms: D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011379:Prognosis; D012445:Sacrococcygeal Region; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000401:mortality; D013724:Teratoma / Q000175:diagnosis* / Q000401:mortality; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014481:United States / Q000453:epidemiology
keywords: Fetal; Outcomes; Sacrococcygeal teratoma; TFR