Role of Neuron-Specific Enolase, Metanephrine, Procalcitonin, Lactate Dehydrogenase, and Ferritin in children with Neuroblastoma and Wilms tumor

Abstract

The role of enolase isozymes and ferritin as biomarkers in pediatric solid tumors, including neuroblastoma and Wilms tumor. While neuron-specific enolase (NSE) is well-established in neuroendocrine tumors, its expression patterns and prognostic significance in other childhood cancers remain underexplored. Similarly, ferritin, traditionally linked to iron metabolism and inflammation, may have unrecognized associations with tumor aggressiveness or treatment response in these malignancies. dysregulated enolase isoforms and altered ferritin levels correlate with disease progression, metastatic potential, or therapeutic outcomes in pediatric solid tumors. Patient and methods: This case-control study, conducted at Baghdad Teaching Hospital (February–December 2024), evaluated Neuron-Specific Enolase (NSE) and ferritin as potential biomarkers in pediatric solid tumors. The study included 98 children under 10 years old, divided into three groups: 34 neuroblastoma patients, 31 Wilms tumor patients, and 33 healthy controls. Serum levels of NSE, ferritin and LDH were measured using Roche Cobas while  PCT and Metanephrine measured by ELISA. Results: A total of 98 children participated: 33 as healthy controls, 31 diagnosed with Wilms' tumor, and 34 with neuroblastoma. The average ages for each group were similar: 39.35 ± 4.84 months for neuroblastoma, 40.03 ± 4.36 months for Wilms tumor, and 40.85 ± 5.58 months for the control group. There was no statistically significant difference (p ≥ 0.980). There were no significant differences in weight (p ≥ 0.942), height (p ≥ 0.960), or sex distribution (p ≥ 0.679). NSE levels were significantly elevated in neuroblastoma patients (mean: 51.35 ng/mL) compared to Wilms tumor patients (38.82 ng/mL) and controls (16.94 ng/mL). PCT levels also followed a similar pattern, with an average of 1.41 ng/mL for neuroblastoma, 0.99 ng/mL for Wilms, and 0.36 ng/mL for controls. In the neuroblastoma cohort, NSE and PCT levels exhibited a statistically significant modest positive correlation (r = 0.367, p < 0.0329). According to ROC curve research, PCT had an AUC of 0.862 and NSE had an AUC of 0.921 for telling the difference between neuroblastoma and controls. Although elevated in both tumor groups, metanephrine, LDH, and ferritin exhibited no statistically significant correlations with clinical or anthropometric criteria and demonstrated lower AUC values, thereby indicating limited standalone diagnostic relevance. Conclusion: Serum neuron-specific enolase NSE shows exceptional elevation in neuroblastoma, while ferritin is markedly increased in Wilms tumor, suggesting their potential diagnostic utility in differentiating these pediatric malignancies.