Li Xiaozhi, Meng Yutong
Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China.
PeerJ. 2019 Jul 11;7:e7316. doi: 10.7717/peerj.7316. eCollection 2019.
Neuroblastoma is one of the most common extracranial solid tumors in children, which accounts for about 7-10% in children's tumors. The prognosis group of patients with neuroblastoma could not only improve the efficacy of high-risk patients, but also reduce the effects of drug complications for surviving patients.
Patients diagnosed with neuroblastoma between 1986 and 2012 were selected form the TARGET database. The nomogram was built with potential risk factors based on COX regression analysis. The precision of the 3-year and 5-year survival of the nomograms was evaluated by the area under receiver operating characteristic (ROC) curve (AUC).
A total of 757 child neuroblastoma patients were selected from the TARGET database. Univariate analysis showed that age of diagnosis (>520 day), race of American Indian or Alaska Native, stage 4 in International Neuroblastoma Staging System (INSS), status, DNA ploidy, and high mitosis-karyorrhexis index were associated with overall survival (OS). Multivariate analysis showed age of diagnosis (>520 day), stage 4 in INSS and DNA ploidy were independent risk factors of OS. The concordance index (C-index) of the nomogram was 0.704 (95% CI [0.686-0.722]) in the training cohort while the C-index in the validation cohort was 0.672 (95% CI [0.644-0.700]). AUC values of ROC curves for 3-year OS and 5-year OS in the training cohort were 0.732 and 0.772, respectively. The nomogram performed better compared with INSS staging system, tumor histology and children's oncology group (COG) risk group with C-indexes of 0.662 (95% CI [0.648-0.676]), 0.637 (95% CI [0.622-0.652]) and 0.651 (95% CI [0.637-0.665]), respectively.
The nomogram showed stronger predictive power than the INSS staging system, tumor histology and COG risk group. Precise estimates of the prognosis of childhood neuroblastoma might help doctors make better treatment decisions.
神经母细胞瘤是儿童最常见的颅外实体瘤之一，约占儿童肿瘤的7%-10%。神经母细胞瘤患者的预后分组不仅可以提高高危患者的疗效，还能减少存活患者的药物并发症影响。
从TARGET数据库中选取1986年至2012年间诊断为神经母细胞瘤的患者。基于COX回归分析，利用潜在风险因素构建列线图。通过受试者操作特征（ROC）曲线下面积（AUC）评估列线图3年和5年生存率的准确性。
共从TARGET数据库中选取757例儿童神经母细胞瘤患者。单因素分析显示，诊断年龄（>520天）、美洲印第安人或阿拉斯加原住民种族、国际神经母细胞瘤分期系统（INSS）4期、状态、DNA倍体以及高有丝分裂-核碎裂指数与总生存期（OS）相关。多因素分析显示，诊断年龄（>520天）、INSS 4期和DNA倍体是OS的独立危险因素。列线图在训练队列中的一致性指数（C指数）为0.704（95%CI[0.686-0.722]），而在验证队列中的C指数为0.672（95%CI[0.644-0.700]）。训练队列中3年OS和5年OS的ROC曲线AUC值分别为0.732和0.772。与INSS分期系统、肿瘤组织学和儿童肿瘤学组（COG）风险组相比，列线图表现更佳，其C指数分别为0.66（95%CI[0.648-0.676]）、0.637（95%CI[0.622-0.652]）和0.651（95%CI[0.637-0.665]）。
列线图显示出比INSS分期系统、肿瘤组织学和COG风险组更强的预测能力。对儿童神经母细胞瘤预后的精确估计可能有助于医生做出更好的治疗决策。
