title: Prognostic significance of gene expression profiles of metastatic neuroblastomas lacking MYCN gene amplification.
abstract: BACKGROUND
  The aggressiveness of metastatic neuroblastomas that lack MYCN gene amplification varies with age--they are least aggressive when diagnosed in patients younger than 12 months and most aggressive when diagnosed in patients older than 24 months. However, age at diagnosis is not always associated with patient survival. We examined whether molecular classification of metastatic neuroblastomas without MYCN gene amplification at diagnosis using gene expression profiling could improve the prediction of risk of disease progression.
  
  
  METHODS
  We used Affymetrix microarrays to determine the gene expression profiles of 102 untreated primary neuroblastomas without MYCN gene amplification obtained from children whose ages at diagnosis ranged from 0.1 to 151 months. A supervised method using diagonal linear discriminant analysis was devised to build a multigene model for predicting risk of disease progression. The accuracy of the model was evaluated using nested cross-validations, permutation analyses, and gene expression data from 15 additional tumors obtained at disease progression.
  
  
  RESULTS
  An expression profile model using 55 genes defined a tumor signature that distinguished two groups of patients from among those older than 12 months at diagnosis and clinically classified as having high-risk disease, those with a progression-free survival (PFS) rate of 16% (95% confidence interval [CI] = 8% to 28%), and those with a PFS rate of 79% (95% CI = 57% to 91%) (P<.01). These tumor signatures also identified two groups of patients with PFS of 15% (95% CI = 7% to 27%) and 69% (95% CI = 40% to 86%) (P<.01) from among patients who were older than 18 months at diagnosis. The gene expression signature of untreated molecular high-risk tumors was also present in progressively growing tumors.
  
  
  CONCLUSIONS
  Gene expression signatures of tumors obtained at diagnosis from patients with clinically indistinguishable high-risk, metastatic neuroblastomas identify subgroups with different outcomes. Accurate identification of these subgroups with gene expression profiles may facilitate development, implementation, and analysis of clinical trials aimed at improving outcome.
authors.affiliation: Department of Pediatrics, Division of Hematology-Oncology, Childrens Hospital Los Angeles and Saban Research Institute, University of Southern California, Los Angeles, CA, USA.
authors.forename: Shahab
authors.initials: S
authors.lastname: Asgharzadeh
authors.forename: Roger
authors.initials: R
authors.lastname: Pique-Regi
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.forename: Yujun
authors.initials: Y
authors.lastname: Yang
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimada
authors.forename: Katherine
authors.initials: K
authors.lastname: Matthay
authors.forename: Jonathan
authors.initials: J
authors.lastname: Buckley
authors.forename: Antonio
authors.initials: A
authors.lastname: Ortega
authors.forename: Robert C
authors.initials: RC
authors.lastname: Seeger
mesh_terms: D000293:Adolescent; D014408:Biomarkers, Tumor / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D016002:Discriminant Analysis; D018450:Disease Progression; D005260:Female; D005784:Gene Amplification; D020869:Gene Expression Profiling; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000071447:N-Myc Proto-Oncogene Protein; D009447:Neuroblastoma / Q000235:genetics* / Q000556:secondary; D009687:Nuclear Proteins / Q000235:genetics*; D015513:Oncogene Proteins / Q000235:genetics*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; C459801:MYCN protein, human; D000071447:N-Myc Proto-Oncogene Protein; D009687:Nuclear Proteins; D015513:Oncogene Proteins