Traditional and emerging molecular markers in neuroblastoma prognosis: Thegood, the bad and the ugly

Background: Neuroblastomas (NB) are a heterogeneous group of childhood tumo urs with a wide range of likelihood for tumour progression. As traditional parameters do not ensure completely accurate prognostic grouping, new molec ular markers are needed for assessing the individual patient's prognosis mo re precisely. Patients and Methods: 133 NB of all stages were analysed in b lind-trial fashion for telomerase activity (TA), expression of survivin, an d MYCN status. These data were correlated with other traditional prognostic indicators and disease outcome. Results and Conclusions: TA is a powerful independent prognostic marker for all stages and is capable of differentiat ing between good and poor outcome in putative "favourable" clinical or biol ogical subgroups of NB patients. High survivin expression is associated wit h an adverse outcome, but is more difficult to interprete than TA because s urvivin expression needs to be accurately quantified to be of predictive va lue. We propose an extended progression model for NB including emerging pro gnostic markers, with emphasis on telomerase activity.