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The prognosis of children with metastatic neuroblastoma (NB) > 18 months at diagnosis is dismal. Since the immune status of the tumor microenvironment could play a role in the history of disease, we evaluated the expression of  CD45 ,  CD14 ,  ARG1 ,  CD163 ,  CD4 ,  FOXP3 ,  Perforin-1  ( PRF1 ),  Granzyme B (GRMB) , and  IL-10  mRNAs in primary tumors at diagnosis from children with metastatic NB and tested whether the transcript levels are significantly associated to event-free and overall survival (EFS and OS, resp.). Children with high expression of  CD14 ,  ARG1  and  FOXP3  mRNA in their primary tumors had significantly better EFS. Elevated expression of  CD14 , and  FOXP3  mRNA was significantly associated to better OS.  CD14  mRNA expression levels significantly correlated to all markers, with the exception of  CD4 . Strong positive correlations were found between  PRF1  and  CD163 , as well as between  PFR1  and  FOXP3 . It is worth noting that the combination of high levels of  CD14 ,  FOXP3 , and  ARG1  mRNAs identified a small group of patients with excellent EFS and OS, whereas low levels of  CD14  were sufficient to identify patients with dismal survival. Thus, the immune status of the primary tumors of high-risk NB patients may influence the natural history of this pediatric cancer.

Expression ofFOXP3,CD14, andARG1in Neuroblastoma Tumor Tissue from High-Risk Patients Predicts Event-Free and Overall Survival