Revised risk estimation and treatment stratification of low- and intermediate-risk neuroblastoma patients by integrating clinical and molecular prognostic markers

To optimize neuroblastoma treatment stratification, we aimed at developing a novel risk estimation system by integrating gene expression-based classification and established prognostic markers. Gene expression profiles were generated from 709 neuroblastoma specimens using customized 4 × 44 K microar...

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Published in:	Clinical cancer research 2015-04, Vol.21 (8), p.1904-1915
Main Authors:	Oberthuer, André, Juraeva, Dilafruz, Hero, Barbara, Volland, Ruth, Sterz, Carolina, Schmidt, Rene, Faldum, Andreas, Kahlert, Yvonne, Engesser, Anne, Asgharzadeh, Shahab, Seeger, Robert, Ohira, Miki, Nakagawara, Akira, Scaruffi, Paola, Tonini, Gian Paolo, Janoueix-Lerosey, Isabelle, Delattre, Olivier, Schleiermacher, Gudrun, Vandesompele, Jo, Speleman, Frank, Noguera, Rosa, Piqueras, Marta, Bénard, Jean, Valent, Alexander, Avigad, Smadar, Yaniv, Isaac, Grundy, Richard G, Ortmann, Monika, Shao, Chunxuan, Schwab, Manfred, Eils, Roland, Simon, Thorsten, Theissen, Jessica, Berthold, Frank, Westermann, Frank, Brors, Benedikt, Fischer, Matthias
Format:	Article
Language:	eng
Subjects:	Biomarkers, Tumor - genetics Cluster Analysis Female Follow-Up Studies Gene Expression Profiling Gene Expression Regulation, Neoplastic Humans Kaplan-Meier Estimate Male Neuroblastoma - diagnosis Neuroblastoma - genetics Neuroblastoma - mortality Neuroblastoma - therapy Prognosis Regression Analysis Reproducibility of Results Risk Assessment Risk Factors
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Summary:	To optimize neuroblastoma treatment stratification, we aimed at developing a novel risk estimation system by integrating gene expression-based classification and established prognostic markers. Gene expression profiles were generated from 709 neuroblastoma specimens using customized 4 × 44 K microarrays. Classification models were built using 75 tumors with contrasting courses of disease. Validation was performed in an independent test set (n = 634) by Kaplan-Meier estimates and Cox regression analyses. The best-performing classifier predicted patient outcome with an accuracy of 0.95 (sensitivity, 0.93; specificity, 0.97) in the validation cohort. The highest potential clinical value of this predictor was observed for current low-risk patients [5-year event-free survival (EFS), 0.84 ± 0.02 vs. 0.29 ± 0.10; 5-year overall survival (OS), 0.99 ± 0.01 vs. 0.76 ± 0.11; both P < 0.001] and intermediate-risk patients (5-year EFS, 0.88 ± 0.06 vs. 0.41 ± 0.10; 5-year OS, 1.0 vs. 0.70 ± 0.09; both P < 0.001). In multivariate Cox regression models for low-risk/intermediate-risk patients, the classifier outperformed risk assessment of the current German trial NB2004 [EFS: hazard ratio (HR), 5.07; 95% confidence interval (CI), 3.20-8.02; OS: HR, 25.54; 95% CI, 8.40-77.66; both P < 0.001]. On the basis of these findings, we propose to integrate the classifier into a revised risk stratification system for low-risk/intermediate-risk patients. According to this system, we identified novel subgroups with poor outcome (5-year EFS, 0.19 ± 0.08; 5-year OS, 0.59 ± 0.1), for whom we propose intensified treatment, and with beneficial outcome (5-year EFS, 0.87 ± 0.05; 5-year OS, 1.0), who may benefit from treatment de-escalation. Combination of gene expression-based classification and established prognostic markers improves risk estimation of patients with low-risk/intermediate-risk neuroblastoma. We propose to implement our revised treatment stratification system in a prospective clinical trial.
ISSN:	1078-0432 1557-3265