Insulin-like growth factor II mRNA-binding protein 3 (IMP3) has been reported to enhance proliferation and invasion in various cancers. The role of IMP3 on neuroblastoma (NB) is unknown. We aimed to clarify the prognostic significance of IMP3 expression in patients with NB. By microarray analysis, high IMP3 expression was found in patients with poor outcome. IMP3 expression in 90 NB samples was analyzed by immunohistochemical staining to correlate with clinical stages, histology, and patient outcome. Positive IMP3 expression was detected in 52 of 90 patients, and was significantly correlated with undifferentiated histology, advanced stages, MYCN amplification, and poor outcome. In subgroups, positive IMP3 expression could predict an even worse prognosis in patients with advanced disease, with normal MYCN status, or with MYCN amplification (P = 0.005, P = 0.001, and P = 0.033, respectively). The IMP3 expression decreased by induction of differentiation with retinoid acid treatment in SK-N-DZ and SK-N-SH cells in vitro. The invasion ability of NB cells also decreased as IMP3 knockdown by using RNA interference in vitro. In summary, high expression of IMP3 in NB might contribute to the undifferentiated phenotype and invasive behaviors, leading to a poor prognosis. Determining IMP3 expression in NB could help to improve a personalized therapy. (Cancer Sci 2011; 102: 2191-2198 N euroblastoma (NB), a common cancer of early childhood that originates from primitive sympathetic neural precursors, has a remarkable heterogeneity of clinical behaviors ranging from spontaneous regression to rapid progression and death. Therapeutic options are proposed according to the Children's Oncology Group risk stratification criteria based on clinical and biological factors, including clinical stage, MYCN status, age at diagnosis, histology, and ploidy status.(1,2) Treatment strategy, which ranges from observation alone to intensive multimodal therapy, depends on the risk stratification of the patient in one of the three subgroups of low-, intermediate-, and high-risk of death. Although several biological and molecular prognostic factors have been identified, amplification of the MYCN oncogene, which occurs in roughly 20% of primary NB, is one of the most powerful prognostic factors in NB.(3) The co-opting neurotrophin pathways including the neurotrophin receptors (TrkA, TrkB, and TrkC) and their ligands (NGF, BDNF, and neurotrophin-3, respectively), which regulate the differentiation, apoptosis, and growth of neural cells, are also important prognosis-related factors in NB.(4) However, some patients with a normal MYCN copy number still present with clinically aggressive progression similar to those with MYCN-amplified tumors, suggesting that other unfavorable molecules determining inferior survival may exist.(5,6)The insulin-like growth factor II mRNA-binding protein 3 (IMP3), also known as L532S or K homology domain-containing protein overexpressed in cancer (KOC), is a member of the RNA-binding protein family that includes IMP1, IMP2...