Details

Autor(en) / Beteiligte

• 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

Titel

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

Ist Teil von

• Clinical cancer research, 2015-04, Vol.21 (8), p.1904-1915

Ort / Verlag

United States

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.