21 yrs old patient with Ewing sarcoma having radio & chemo therapy which pf the following indicates poor prognosis?
Prognostic factors for EWINGS SARCOMA
a. The worst prognostic factor is the presence of distant metastases. Even with aggressive treatment, patients with metastases have only a 20% chance of long-term survival.
b. The size of the primary lesion has been shown consistently to be of prognostic significance, although specific parameters have not been firmly established.
c. Location also has been reported to be of prognostic significance, but it is difficult to differentiate the effects of location and size because most proximally located tumors are larger at presentation than distally located tumors.
d. Histological grade is of no prognostic significance because all Ewing sarcomas are considered high grade.
e. Fever, anemia, and elevation of laboratory values (white blood cell count, erythrocyte sedimentation rate, lactate dehydrogenase) have been reported to indicate more extensive disease and a worse prognosis.
f. Older age at presentation (with a cutoff around 12 to 15 years old) and male gender also have been reported to be associated with a worse prognosis.
g. The specific translocation, t(11;22) versus t(21;22), does not seem to affect the clinical course; however, secondary genetic alterations, such as aberrant p53 expression, may prove to be important. As with osteosarcoma, histological response to neoadjuvant chemotherapy has been shown to be prognostically important.