title: Lung metastases in neuroblastoma at initial diagnosis: A report from the International Neuroblastoma Risk Group (INRG) project.
abstract: BACKGROUND
  Neuroblastoma is the most common extracranial pediatric solid cancer. Lung metastasis is rarely detected in children with newly diagnosed neuroblastoma. We aimed to describe the incidence, clinical characteristics, and outcome of patients with lung metastasis at initial diagnosis using a large international database.
  
  
  METHODS
  The subset of patients from the International Neuroblastoma Risk Group database with INSS stage 4 neuroblastoma and known data regarding lung metastasis at diagnosis was selected for analysis. Clinical and biological characteristics were compared between patients with and without lung metastasis. Survival for patients with and without lung metastasis was estimated by Kaplan-Meier methods. Cox proportional hazards methods were used to determine the independent prognostic value of lung metastasis at diagnosis.
  
  
  RESULTS
  Of the 2,808 patients with INSS stage 4 neuroblastoma diagnosed between 1990 and 2002, 100 patients (3.6%) were reported to have lung metastasis at diagnosis. Lung metastasis was more common among patients with MYCN amplified tumors, adrenal primary tumors, or elevated lactate dehydrogenase (LDH) levels (P < 0.02 in each case). Five-year overall survival +/- standard error for patients with lung metastasis was 34.5% +/- 6.8% compared to 44.7% +/- 1.3% for patients without lung metastasis (P = 0.0002). However, in multivariable analysis, the presence of lung metastasis was not independently predictive of outcome.
  
  
  CONCLUSIONS
  Lung metastasis at initial diagnosis of neuroblastoma is associated with MYCN amplification and elevated LDH levels. Although lung metastasis at diagnosis was not independently predictive of outcome in this analysis, it remains a useful prognostic marker of unfavorable outcome.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, California, USA. duboiss@peds.ucsf.edu
authors.forename: Steven G
authors.initials: SG
authors.lastname: Dubois
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
authors.forename: Tom
authors.initials: T
authors.lastname: Monclair
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ambros
authors.forename: Susan L
authors.initials: SL
authors.lastname: Cohn
authors.forename: Andrew
authors.initials: A
authors.lastname: Pearson
authors.forename: Lisa
authors.initials: L
authors.lastname: Diller
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000556:secondary*; D000071447:N-Myc Proto-Oncogene Protein; D009447:Neuroblastoma / Q000401:mortality / Q000556:secondary*; D009687:Nuclear Proteins / Q000235:genetics; D015513:Oncogene Proteins / Q000235:genetics
chemical_list: C459801:MYCN protein, human; D000071447:N-Myc Proto-Oncogene Protein; D009687:Nuclear Proteins; D015513:Oncogene Proteins; D007770:L-Lactate Dehydrogenase