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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
Clinical cancer research, 04/2015, Volume: 21, Issue: 8Journal Article
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.
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