MYCN amplification is the most significant poor prognostic marker in neuroblastoma patients.270MYCN amplification is present in around 20–30% of neuroblastoma patients, and survival in these patients is less than 50%.18,271 Low risk patients lacking MYCN amplification can never progress to high-risk disease.272,273 In high-risk patients with upregulation of MYCN, amplification is always present at diagnosis, thus, amplification of MYCN is an early factor which is perhaps driving development of aggressive phenotypes in young patients. The gene discussed is MYCN; the disease is neuroblastoma.