Clinical Significance of Tumor-Associated Inflammatory Cells in Metastatic Neuroblastoma

TLDR

Children diagnosed at ≥18 months with metastatic MYCN‑nonamplified neuroblastoma face high relapse risk, whereas those diagnosed before 18 months are almost always cured. The study tests whether expression of tumor‑associated inflammatory genes explains age‑related survival differences and can form a prognostic signature. Researchers quantified TAM infiltration by immunohistochemistry and measured 44 tumor‑ and inflammation‑related genes in 133 metastatic NBL‑NA samples, building a logistic regression model that produced low‑ and high‑risk scores and validated it in two independent cohorts. The 14‑gene score, including TAM markers, contributed 25% of its predictive accuracy, and high‑risk patients had markedly lower 5‑year PFS (e.g., 47% vs 12%) across three trials, underscoring the.

Abstract

Children diagnosed at age ≥ 18 months with metastatic MYCN-nonamplified neuroblastoma (NBL-NA) are at high risk for disease relapse, whereas those diagnosed at age < 18 months are nearly always cured. In this study, we investigated the hypothesis that expression of genes related to tumor-associated inflammatory cells correlates with the observed differences in survival by age at diagnosis and contributes to a prognostic signature.Tumor-associated macrophages (TAMs) in localized and metastatic neuroblastomas (n = 71) were assessed by immunohistochemistry. Expression of 44 genes representing tumor and inflammatory cells was quantified in 133 metastatic NBL-NAs to assess age-dependent expression and to develop a logistic regression model to provide low- and high-risk scores for predicting progression-free survival (PFS). Tumors from high-risk patients enrolled onto two additional studies (n = 91) served as independent validation cohorts.Metastatic neuroblastomas had higher infiltration of TAMs than locoregional tumors, and metastatic tumors diagnosed in patients at age ≥ 18 months had higher expression of inflammation-related genes than those in patients diagnosed at age < 18 months. Expression of genes representing TAMs (CD33/CD16/IL6R/IL10/FCGR3) contributed to 25% of the accuracy of a novel 14-gene tumor classification score. PFS at 5 years for children diagnosed at age ≥ 18 months with NBL-NA with a low- versus high-risk score was 47% versus 12%, 57% versus 8%, and 50% versus 20% in three independent clinical trials, respectively.These data suggest that interactions between tumor and inflammatory cells may contribute to the clinical metastatic neuroblastoma phenotype, improve prognostication, and reveal novel therapeutic targets.