Prognostic value of semi-quantitative score based on 123I-MIBG SPECT/CT in Chinese pediatric patients with stage 4 high-risk neuroblastoma after induction chemotherapy

Background As Curie score derived from ¹²³ I-MIBG SPECT/CT exhibits superior accuracy while maintaining excellent concordance with the gold standard compared to planar imaging, our study aimed to assess the prognostic value of a semi-quantitative scoring system based on ¹²³ I-MIBG SPECT/CT imaging for predicting outcomes in Chinese pediatric patients with stage 4 high-risk neuroblastoma following induction chemotherapy. Results We retrospectively analyzed a cohort of 116 pediatric patients diagnosed with stage 4 high-risk neuroblastoma who underwent induction chemotherapy followed by ¹²³ I-MIBG SPECT/CT imaging in our department. The optimal cut-off value for the Curie score after induction was determined to be 6 based on the Youden index. Cox multifactorial analysis revealed that Curie score > 6, presence of neuroblastoma pathology, MYCN amplification and 11q23 aberration could serve as independent predictors of progression-free survival (PFS). Children with Curie scores > 6 (n = 29) after induction had significantly lower progression-free survival compared to those with Curie scores ≤ 6 (n = 87) (1-year PFS: 55.2%±9.2% vs. 79.3%±4.3%, 3-year PFS: 15.1%±8.3% vs. 54.7%±5.9%, P < 0.001). For children with/without MYCN-amplified and 11q23 aberration neuroblastoma, higher Curie scores (> 6) were associated with significantly worse outcomes. But for children without 11q23 aberration neuroblastoma, there was no significant difference in Curie score after induction. Conclusions The present study proposes that the Curie score, derived from ¹²³ I-MIBG SPECT/CT imaging following induction chemotherapy, exhibits a robust correlation with the prognosis of Chinese pediatric patients diagnosed with MIBG avid stage 4 high-risk neuroblastoma. Specifically, patients achieving a CS of 6 or lower after induction chemotherapy demonstrate enhanced benefits from consolidation and maintenance treatment regimens. Consequently, further investigation is warranted to explore individualized therapeutic approaches for Chinese pediatric patients afflicted with stage 4 high-risk neuroblastoma.