{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:46:22Z","timestamp":1794473182492,"version":"4.9.1"},"reference-count":33,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2014,11,1]],"date-time":"2014-11-01T00:00:00Z","timestamp":1414800000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Dev Pathol"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:p>Prognostic effects of Mitosis-Karyorrhexis Index (MKI) used in the International Neuroblastoma Pathology Classification (INPC) are age-dependent. A total of 4,282 neuroblastomas reviewed at the Children's Oncology Group Neuroblastoma Pathology Reference Laboratory (8\/1\/2001\u20133\/31\/2012) included 2,365 low-MKI (L-MKI), 1,068 intermediate-MKI (I-MKI), and 849 high-MKI (H-MKI) tumors. Cox proportional hazards models were fit to determine age cut-offs at which the relative risk of event\/death was maximized in each MKI class. Backward-selected Cox models were fit to determine the prognostic strength of the age cut-offs for survival in the presence of other prognostic factors. The age cut-offs used in the INPC for L-MKI tumors (&lt;60 months, n = 2,710, 84.0% \u00b1 1.0% event-free survival [EFS], 93.8 \u00b1 0.7% overall survival [OS] vs \u226560 months, n = 195, 49.8% \u00b1 4.6% EFS, 71.7% \u00b1 4.1% OS; P &lt; 0.0001) and I-MKI tumors (&lt;18 months, n = 568, 83.8% \u00b1 2% EFS, 93.7% \u00b1 1.3% OS vs \u226518 months, n = 500, 51.4% \u00b1 2.9% EFS, 66.7% \u00b1 2.7% OS; P &lt; 0.0001) were within the effective range for distinguishing prognostic groups. As for H-MKI tumors (no cut-off age in the INPC, 51.0% \u00b1 2.2% EFS, 64.4% \u00b1 2.1% OS), a new cut-off of 3\u20134 months was suggested (&lt;4 months, n = 38, 82.3% \u00b1 8.4% EFS, 81.8% \u00b1 8.5% OS vs \u22654 months, n = 811, 49.6% \u00b1 2.2% EFS, 63.7% \u00b1 2.1% OS, P = 0.0034 and 0.0437, respectively). Multivariate analyses revealed that cut-offs of 60 and 18 months for L-MKI and I-MKI tumors, respectively, were independently prognostic. However, the cut-off of 4 months for H-MKI tumors did not reach statistical significance in the presence of other factors. The age cut-offs for MKI classes (60 months for L-MKI, 18 months for I-MKI, no cut-off for H-MKI) in the current INPC are reasonable and effective for distinguishing prognostic groups with increased risk of event\/death for older patients.<\/jats:p>","DOI":"10.2350\/14-06-1505-oa.1","type":"journal-article","created":{"date-parts":[[2014,12,8]],"date-time":"2014-12-08T11:04:29Z","timestamp":1418036669000},"page":"441-449","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":45,"title":["Age-Dependent Prognostic Effect by Mitosis-Karyorrhexis Index in Neuroblastoma: A Report from the Children's Oncology Group"],"prefix":"10.1177","volume":"17","author":[{"given":"Risa","family":"Teshiba","sequence":"first","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, and University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS #43, Los Angeles, CA 90027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Kawano","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, and University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS #43, Los Angeles, CA 90027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry L.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, and University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS #43, Los Angeles, CA 90027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lejian","family":"He","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, and University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS #43, Los Angeles, CA 90027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlene","family":"Naranjo","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Children's Oncology Group Statistics and Data Center, University of Florida, 6011 NW 1st Place, Gainesville, FL 32607, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy B.","family":"London","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology and Children's Oncology Group Statistics and Data Center, Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Seeger","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Children's Hospital Los Angeles, and University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS #57, Los Angeles, CA 90027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Gastier-Foster","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, 700 Childrens Drive, Columbus, OH 43205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Thomas","family":"Look","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Hogarty","sequence":"additional","affiliation":[{"name":"Division of Oncology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Cohn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Hematology\/Oncology, University of Chicago, 5721 S. Maryland Avenue, Chicago, IL 60637, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Maris","sequence":"additional","affiliation":[{"name":"Division of Oncology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine and Fred Hutchinson Cancer Research center, 4800 Sand Point Way NE, Seattle, WA 98105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Shimada","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Children's Hospital Los Angeles, and University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS #43, 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