Abstract

High risk neuroblastoma (HR-NB) remains one of the most difficult-to-treat pediatric cancers. However, although current risk-stratification is based on multiple pretreatment criteria, HR-NB remains a significant heterogeneity. We examined 60 patients with HR-NB for a median follow-up time of 28 months. We examined the serum neuronspecific enolase (NSE) levels of each chemo cycle, using the survival receiver operating characteristic (survivalROC) method to assess the prognostic power of NSE levels at variant chemo points. We demonstrated that serum NSE was associated with systemic tumor burden. NSE after the third chemo cycle (C3) (C3NSE) was significantly higher in patients who eventually showed cancer relapse or progression. C3NSE had independent prognostic significance for event-free survival (EFS) but not for overall survival (OS) in multivariate cox analysis. SurvivalROC prompted that the C3NSE is a prognostic marker of HR-NB, which had good discrimination for 2- and 3-year EFS with AUC 0.734 and 0.729, respectively. However, its prognositc value for 2- and 3- year OS declined progressively. C3 is the optimal point to predict EFS. Patients whose C3 serum NSE remain at higher level need to undergo more intensive treatment as early as possible to resist recurrence.

摘要

高危神经母细胞瘤 (HR-NB) 仍然是最难治疗的儿科癌症之一。然而，尽管目前的风险分层基于多个预处理标准，但 HR-NB 仍然存在显着的异质性。我们检查了 60 名 HR-NB 患者，中位随访时间为 28 个月。我们检查了每个化疗周期的血清神经元特异性烯醇化酶 (NSE) 水平，使用生存接受者操作特征 (survivalROC) 方法来评估不同化疗点 NSE 水平的预后能力。我们证明血清 NSE 与全身肿瘤负荷有关。在最终显示癌症复发或进展的患者中，第三个化疗周期 (C3) (C3NSE) 后的 NSE 显着更高。在多变量 cox 分析中，C3NSE 对无事件生存期 (EFS) 具有独立的预后意义，但对总生存期 (OS) 没有影响。SurvivalROC 提示 C3NSE 是 HR-NB 的预后标志物，其对 2 年和 3 年 EFS 具有良好的辨别力，AUC 分别为 0.734 和 0.729。然而，其 2 年和 3 年 OS 的预后价值逐渐下降。C3 是预测 EFS 的最佳点。C3血清NSE仍处于较高水平的患者需要尽早接受更强化的治疗以抵抗复发。