Biologic Differences between Neuroblastoma Stages IV-S and IV: Measurement of Serum Ferritin and E-Rosette Inhibition in 30 Children

In an examination of the biologic differences between neuroblastoma Stage IV-S (metastases to liver, skin, or bone marrow but not to bone), which has a high likelihood of spontaneous regression, and Stage IV (metastases to bone), which is usually fatal, 13 children with Stage IV-S disease and 17 with Stage IV were studied at diagnosis or shortly thereafter. Serum ferritin levels were elevated in 15 of the 17 children with Stage IV disease, but not in the 13 with Stage IV-S. E-rosette inhibitory factor was not present in the serum of 12 of 13 Stage IV-S patients, but was detected in 12 of 17 Stage IV patients. All 12 Stage IV patients with inhibitory factor had elevated serum ferritin levels. Elevated ferritin levels and E-rosette inhibitory factor appear to distinguish Stage IV neuroblastoma from Stage IV-S. (N Engl J Med. 1981; 305:425–9.) NEUROBLASTOMA is a unique childhood tumor with several unusual features, the most striking of which is spontaneous regression. 1 , 2 Such regression occurs most often in patients with Stage IV-S disease, who make up 10 per cent of the total with neuroblastoma. 3 This stage includes patients with small primary tumors and disseminated disease in the liver, skin, and bone marrow but not in bone. These patients are usually infants; in one series the median age was three months. 4 The course of the disease in these children is very different from the more common pattern of distant spread, usually to the bony skeleton, . . .