Evolving significance of prognostic markers associated with treatment improvement in patients with stage 4 neuroblastoma
Evolving significance of prognostic markers associated with treatment improvement in patients with stage 4 neuroblastoma
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DOI：
10.1002/cncr.10548
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发表时间：
2002-05-15
期刊：
影响因子：
6.2
通讯作者：
Cheung, NKV
中科院分区：
文献类型：
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作者：
Mora, J;Gerald, WL;Cheung, NKV
背景资料。随着神经母细胞瘤(NB)患者治疗和预后的近期改善，作者重新评估了在纪念斯隆-凯特琳癌症中心(MSKCC)接受治疗的4期NB患者的临床和生物标志物对预后的重要性2。方法：作者分析了1987-1999年间在MSKCC接受N5、N6或N7方案治疗的84例4期NB患者。临床因素(年龄、血清铁蛋白和乳酸脱氢酶[LDII]水平)、组织病理学(国际神经母细胞瘤病理学分类[INPC])和肿瘤生物标志物(MYCN：倍体；1p36、1p22、11q23、14q12-q32、9p21和19q13的杂合性缺失；17q的增加)对生存的影响进行了单因素和多因素模型分析。结果：84名患者中有46人在本报告时存活(55%)，从确诊之日起的中位随访时间为41个月。在单因素分析中，年龄、血清铁蛋白和LDH水平对预后没有影响，在单因素分析中，11q23位MYCN、1p36 LOH、14q32 LOH或17q增强型LOH与无进展生存率(P=-0.04)和生存率(P-0.04)显著相关。在多因素分析中，11q23状态是与总存活率相关的最显著的变量(风险比，0.50；95%可信区间，0.26-0.99)。11q23和1p22的杂合性缺失显著相关(P=0.02)。研究发现，11q23状态和INPC评分是与无进展生存相关的最重要的变量。结论：由于患者的生存随着更有效的治疗而改善，传统的预后标记物，如年龄、MYCN扩增和血清LDH水平升高，对于4NB期患者来说已经变得不那么重要了。在目前的研究中，不太常见的染色体异常(1p22和11q23处的LOH)似乎具有新的重要性。(C)2002年美国癌症协会。
BACKGROUND. With recent improvements in the treatment and Outcome of patients with neuroblastoma (NB), the authors reassessed the prognostic importance 2 of clinical and biologic markers in patients with Stage 4 NB who were treated at the Memorial Sloan-Kettering Cancer Center (MSKCC).METHODS. The authors analyzed 84 patients with Stage 4 NB who were treated oil the N5, N6, or N7 protocols at MSKCC from 1987 to 1999. The impact on survival of clinical factors (age, serum ferritin, and lactate dehydrogenase [LDII] levels), histopathology (international Neuroblastoma Pathology, Classification [INPC]), and tumor biologic markers (MYCN: ploidy; loss of heterozygosity [LOH] at 1p36, 1p22, 11q23, 14q12-q32, 9p21, and 19q13; and gain at 17q) were analyzed in univariate and multivariate models.RESULTS. Forty-six of 84 patients were alive at the time of this report (55%), with a median follow-up of 41 months from the time of diagnosis. In the univariate analysis, there was no prognostic impact on survival by age, serum ferritin and LDH levels, MYCN, 1p36 LOH, 14q32 LOH, or 17q gain LOH at 11q23 was associated significantly with superior progression free survival (P =- 0.04) and survival (P - 0.04) in the univariate analysis. In the multivariate analysis, it was found that 11q23 status was the most significant variable associated with overall survival (hazard ratio, 0.50; 95% confidence interval, 0.26-0.99). LOH at 11q23 and LOH at 1p22 were hjgl-dy correlated (P = 0.02). It was found that 11q23 status and INPC score were the most significant variables associated with progression free survival.CONCLUSIONS. Because patient survival improves with more effective therapy, traditional prognostic markers, such as age, MYCN amplification, and elevated serum LDH levels, have become less important for patients with Stage 4 NB. In the current study, less common chromosomal abnormalities (LOH at 1p22 and 11q23) appeared to assume new importance. (C) 2002 American Cancer Society.