An 18 gene expression-based score classifier predicts the clinical outcome in stage 4 neuroblastoma

Background: The prognosis of children with metastatic stage 4 neuroblastoma (NB) has remained poor in the past decade. Patients and methods: Using microarray analyses of 342 primary tumors, we here developed and validated an easy to use gene expression-based risk score including 18 genes, which can robustly predict the outcome of stage 4 patients. Results: This classifier was a significant predictor of overall survival in two independent validation cohorts [ cohort 1 (n = 214): P = 6.3 x 10(-5); cohort 2 (n = 27): P = 3.1 x 10(-2)]. The prognostic value of the risk score was validated by multivariate analysis including the established markers age and MYCN status (P = 0.027). In the pooled validation cohorts (n = 241), integration of the risk score with the age and/or MYCN status identified subgroups with significantly differing overall survival (ranging from 35 to 100 %). Conclusion: Together, the 18-gene risk score classifier can identify patients with stage 4 NB with favorable outcome and may therefore improve risk assessment and treatment stratification of NB patients with disseminated disease.