Prognostic Value of a Semi-Quantitative Score Based on 123I-MIBG SPECT/CT in Pediatric Patients With Stage 4 High-Risk Neuroblastoma After Induction Therapy

PURPOSE: The aim of this study was to evaluate the prognostic significance of a semi-quantitative scoring system derived from 123 I-Metaiodobenzylguanidine ( 123 I-MIBG) SPECT/CT imaging in predicting clinical outcomes for pediatric patients with stage 4 high-risk neuroblastoma after induction therapy. METHODS: A retrospective analysis was conducted on a cohort of 116 pediatric patients diagnosed with stage 4 high-risk neuroblastoma. All patients received induction therapy and subsequently underwent 123 I-MIBG SPECT/CT imaging in our department. The Curie score and relevant clinical indicators were assessed, and both univariate and multivariate Cox proportional hazards models were applied to identify independent risk factors associated with disease recurrence. The optimal cutoff value for the Curie score was determined using the Youden index. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: According to the Youden index, the optimal cutoff value for Curie score after induction therapy was established as 6. Patients with a Curie score >6 (n=29) exhibited significantly lower PFS and OS compared with those with a Curie score≤6 (n=87). Specifically, 1-year PFS was 55.2%±9.2% versus 79.3%±4.3%, and 3-year PFS was 15.1%±8.3% versus 54.7%±5.9% ( P <0.001). Similarly, 1-year OS was 70.0%±18.2% versus 89.9%±5.6%, and 3-year OS was 0.0% versus 60.0%±11.8% ( P =0.002). Multivariate Cox regression analysis revealed that a Curie score >6, the presence of neuroblastoma pathology, MYCN amplification, and 11q23 aberration were independent predictors of poor prognosis. Among patients with MYCN-amplified neuroblastoma, a higher Curie score (>6) was significantly associated with worse clinical outcomes. CONCLUSIONS: This study demonstrates that the Curie score derived from 123 I-MIBG SPECT/CT imaging after induction therapy is strongly associated with the prognosis of pediatric patients with MIBG-avid stage 4 high-risk neuroblastoma. Notably, patients achieving a Curie score of 6 or lower after induction therapy may benefit from subsequent consolidation and maintenance treatment strategies.