The Relationship Between Circulating Tumor Cells in Peripheral Blood and Clinical Characteristics of Pediatric Neuroblastoma and Prognostic Evaluation

Objective This study aims to evaluate the relationship between the detection of circulating tumor cells (CTCs) in peripheral blood and the clinical characteristics and prognostic value of advanced (III-IV) pediatric neuroblastoma (NB). Methods This retrospective analysis included 144 children with advanced NB who received comprehensive treatment at our hospital from September 2020 to October 2022. Detailed clinical data of the patients were collected, and CTCs in samples were detected using a negative enrichment method based on immunomagnetic beads adsorption combined with immunofluorescence technology. The prognostic evaluation criteria and cut-off values for CTCs were determined using the receiver operating characteristic (ROC) curve method. Furthermore, univariate and Cox multivariate regression analyses were used to identify independent risk factors affecting the prognosis of children with NB. Results According to the optimal cut-off values obtained from the X-tile software, the patients were divided into high and low expression groups. The number of children with Progress (P < 0.001), Maximum tumor diameter ≥ 10cm (P = 0.004), low differentiation (P = 0.034), and stage IV (P = 0.007) in the high expression group was significantly higher than in the low expression group. The CTCs in children with Progress were higher than those in children with Mitigation (P < 0.001); children with Maximum tumor diameter < 10cm had lower CTCs than those with ≥ 10cm (P < 0.001); stage IV children had higher CTCs than stage III children (P = 0.036). The AUC for Maximum tumor diameter, Degree of differentiation, and Tumor stage were 0.703, 0.669, 0.574, and 0.598, respectively. Multivariate Cox regression analysis showed that CTCs (P < 0.001, OR = 2.958), Efficacy (P = 0.005, OR = 1.814), and Maximum tumor diameter (P < 0.001, OR = 2.586) were independent prognostic factors affecting OS in children with NB. Time-dependent ROC curve analysis showed that the model's AUC for predicting 1-year and 2-year survival was 0.747 and 0.802, respectively. Conclusion CTCs detection can significantly assess the clinical characteristics and prognosis of advanced pediatric NB, and CTCs, Efficacy, and Maximum tumor diameter are independent prognostic factors.