This finding is consistent with reports from several cancer types that found mutation of TP53 is associated with poor response and survival.35 This is also consistent with higher levels of TP53 protein in metastatic versus localized ERMS36 and also observations in zebra fish models of ERMS, where tp53 mutations are linked to more aggressive and metastatic disease.37 Determination of TP53 status in all cases of RMS therefore is critical, both for prognostic value and the implications that germline mutations have for genetic counseling. This evidence concerns the gene TP53 and cancer.