The Prognostic Value of MIBG Metastatic Patterns in Pediatric Patients with High-Risk Stage 4 Neuroblastoma Following Induction Therapy.
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RATIONALE AND OBJECTIVES: The aim of this study was to assess the prognostic value of MIBG metastasis patterns identified by 123I-Metaiodobenzylguanidine (MIBG) single-photon emission computed tomography/computed tomography (SPECT/CT) imaging in pediatric patients with high-risk stage 4 neuroblastoma after induction therapy. MATERIALS AND METHODS: A retrospective analysis was performed on a cohort of 77 pediatric patients with high-risk stage 4 neuroblastoma who underwent induction therapy followed by 123I-MIBG SPECT/CT imaging at our institution. Progression-free survival (PFS) and survival (OS) were estimated using the Kaplan-Meier method, and differences in survival outcomes were assessed using the log-rank test. Categorical variables were analyzed using the chi-square test. Univariate and multivariate Cox proportional hazards regression models were employed to identify independent risk factors associated with diseases recurrence. RESULTS: All children were followed up for a median duration of 1.5 years. Among the 77 children with high-risk stage 4 neuroblastoma after induction therapy, 41 experienced endpoint events (53.2%), including 29 cases of disease recurrence or progression (37.6%) and 12 deaths attributable to ineffective treatment or treatment-related complications (15.6%). Univariate survival analysis revealed that patients with diffuse bone metastasis (n=32) exhibited a significantly lower 3-year PFS rates (11.5%±6.8%) compared to those with focal bone metastasis (56.8%±8.8%) (n = 45). (P<0.05). Further analysis demonstrated that the 3-year PFS and 3-year OS were significantly reduced in patients with skull metastasis (n=38) and axial bone metastasis (n=47) relative to those without such involvement (P<0.05). Multivariate Cox regression analysis identified axial bone metastasis, diffuse bone metastasis, Curie score>2, MYCN amplification, and 11q23 deletion as independent prognostic factors significantly associated with poorer prognosis (P<0.05). CONCLUSION: The presence of diffuse systemic metastasis, axial bone involvement, or skull metastasis is strongly associated with poorer prognosis in pediatric patients with high-risk stage 4 neuroblastoma. Furthermore, axial bone metastasis, diffuse bone metastasis, Curie score>2, MYCN amplification, and 11q23 deletion constitute independent predictors of unfavorable clinical outcomes.