Background Neuroblastoma (NB) is the most frequent solid cancer of early childhood. Owing to the significant heterogeneity of NB, which results in variation in treatment response and outcomes, the International Neuroblastoma Risk Group (INRG) and Children’s Oncology Group (COG) staging systems have been specifically developed to facilitate accurate risk stratification of patients. Our current biological and clinical understanding of neuroblastoma still remains incomplete. Conventional systems may have overlooked some biomarkers that have yet to be discovered. Some low/intermediate-risk cases exhibit aggressive behavior, which highlights the limitations of current risk stratification. Recent studies advocate for the incorporation of Machine Learning(ML) to enhance risk stratification in NB. Case Description Two children (Case 1: male, 9y; Case 2: female, 3y) were classified as low/intermediate-risk by INRG/COG but experienced rapid recurrence and progression. Our previous studies, which focused on Cellular Morphometric Biomarkers (CMBs) in conjunction with large language models (LLM) in NB, reclassified these two cases as high-risk, aligning with their poor outcomes. Conclusion By applying deep learning-based CMBs derived from pathological images and enhanced by LLM, these cases were reclassified as high-risk, thereby highlighting the potential corrective effect of the ML-based stratification model on treatment decisions and confirming its clinical value as an independent prognostic factor.

Chemotherapy remains the primary systemic treatment for patients with neuroblastoma, but the lack of appropriate in vitro tumor microenvironment models has resulted in suboptimal efficacy of chemotherapeutic agents. In this study, we propose innovative bioresponsive hydrogel microfibers that replicate the mechanical properties of extracellular matrix surrounding neuroblastoma cells for assessing tumor drug responses. These microfibers are composed of an alginate/poly (N-Isopropyl acrylamide) shell and a carboxymethyl cellulose core, fabricated by microfluidic technology. Due to the precise manipulation afforded by microfluidics, it is possible to continuously generate fibers that encapsulate cells with uniform size and precise structure. Additionally, the rapid temperature response characteristics enabled the microfibers to mimic the mechanical properties of the extracellular matrix, thereby regulating the cellular pressure environment and rapidly forming highly active three-dimensional tumor spheroids. Ultimately, our findings demonstrate that neuroblastoma spheres within the microfibers display varying sensitivities to different chemotherapy drugs under distinct external pressure conditions. In conclusion, this biomimetic extracellular matrix microfiber offers a dependable foundation for replicating the neuroblastoma microenvironment and facilitating the assessment of clinical drug efficacy.

MRT is a highly malignant tumor that commonly occurs in children. Despite the current multidisciplinary treatment approach combining surgery, chemotherapy, and radiotherapy, the 3-year survival rate for affected children remains significantly low. This article presents three cases where a novel chemotherapy regimen and maintenance therapy were employed in conjunction with surgical and radiation treatments, resulting in favorable therapeutic outcomes. These findings demonstrate the feasibility and potential of the innovative personalized treatment approach utilized. Personalized treatment involves tailoring therapeutic strategies to the specific characteristics and biological behavior of individual patients. This approach holds promise in improving outcomes for children with MRT. Further research and clinical application will contribute to advancing the use of personalized treatment in the management of MRT.

Purpose: To assess the role of image-defined risk factors in clinical practice of neuroblastoma. Methods: A systematic search was conducted to identify articles about IDRFs. Combined overall results were calculated using fixed effects models. Results: The literature search identified 11 articles including 1338 patients for analysis. There was no difference in amplification of MYCN and tumor site (abdominal tumor) between no IDRFs and any IDRFs group, but there was a significant increase of event free survival (OR: 2.43[1.69, 3.49]; P < 0.00001) and overall survival (OR: 3.15[1.68, 5.89]; P = 0.0004) in no IDRFs group. The incidence of complications (OR: 0.21[0.15, 0.30]; P< 0.00001) was higher in patients with any IDRFs. Furthermore, no IDRFs are correlated with higher rate of earlier INSS stage. Conclusions: IDRFs could be an important adjuvant image monitoring method in NB treatment. IDRFs are valuable to evaluate surgical indications for pediatric surgeon, regardless of surgical ability.