Universität zu Köln

Moroz, Veronica, Machin, David, Hero, Barbara, Ladenstein, Ruth, Berthold, Frank ORCID: 0000-0002-7613-1723, Kao, Paige, Obeng, Yaa, Pearson, Andrew D. J., Cohn, Susan L. and London, Wendy B. (2020). The prognostic strength of serum LDH and serum ferritin in children with neuroblastoma: A report from the International Neuroblastoma Risk Group (INRG) project. Pediatr. Blood Cancer, 67 (8). HOBOKEN: WILEY. ISSN 1545-5017

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Abstract

Purpose Age, MYCN status, stage, and histology have been used as neuroblastoma (NB) risk factors for decades. Serum lactate dehydrogenase (LDH) and serum ferritin are reproducible, easily obtained, and prognostic, though never used in risk stratification, except one German trial. We analyzed the prognostic strength of LDH and ferritin, overall, within high-risk NB, and by era, using the International Neuroblastoma Risk Group Data Commons. Patients and methods Children with NB (1990-2016) were categorized into LDH (n = 8867) and ferritin (n = 8575) risk groups using EFS. Cox models compared the prognostic strength of LDH and ferritin to age, MYCN status, and INSS stage. Results Higher LDH conferred worse EFS, overall (5-year EFS) (100-899 IU/L: 76 +/- 0.6%; 0-99 or 900-1399 IU/L: 60 +/- 1.2%; >= 1400 IU/L: 36 +/- 1.2%; P < .0001), and in high-risk NB post-2009 (3-year EFS) (117-381 IU/L: 67 +/- 8.9%; 382-1334 IU/L: 58 +/- 4.4%; 0-116 or >= 1335 IU/L: 46 +/- 3.9%; P = .003). Higher ferritin conferred worse EFS, overall (5-year EFS) (1-29 ng/mL: 87 +/- 0.9%; 0 or 30-89 ng/mL: 74 +/- 0.8%; >= 90 ng/mL: 48 +/- 0.9%; P < .0001), and in high-risk NB post-2009 (3-year EFS) (1-53 ng/mL: 71 +/- 9.3%; 0 or 54-354 ng/mL: 55 +/- 4.7%; >= 355 ng/mL: 34 +/- 6.1%; P = .0008). In multivariable analyses adjusting for age, MYCN, and stage, LDH and ferritin maintained independent prognostic ability (P < .0001; adjusted HRs (95% CI): 1.7 (1.5-1.9), 2.3 (2.0-2.7), respectively). Conclusions LDH and ferritin are strongly prognostic in NB, overall and within high-risk NB patients treated post-2009 with modern therapy. LDH and ferritin show promise for (a) identifying ultra-high-risk; (b) refining risk stratification; and (c) clinical utility in low-/middle-income countries. Routine collection of LDH and ferritin should be reinitiated for evolving NB risk stratification.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Moroz, Veronica UNSPECIFIED UNSPECIFIED UNSPECIFIED Machin, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Hero, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED Ladenstein, Ruth UNSPECIFIED UNSPECIFIED UNSPECIFIED Berthold, Frank UNSPECIFIED orcid.org/0000-0002-7613-1723 UNSPECIFIED Kao, Paige UNSPECIFIED UNSPECIFIED UNSPECIFIED Obeng, Yaa UNSPECIFIED UNSPECIFIED UNSPECIFIED Pearson, Andrew D. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cohn, Susan L. UNSPECIFIED UNSPECIFIED UNSPECIFIED London, Wendy B. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-332554
DOI:	10.1002/pbc.28359
Journal or Publication Title:	Pediatr. Blood Cancer
Volume:	67
Number:	8
Date:	2020
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1545-5017
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LACTATE-DEHYDROGENASE; CHROMOSOME 1P; CLASSIFICATION Multiple languages Oncology; Hematology; Pediatrics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33255