Department of Pediatric Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Department of Pediatric Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
J Pediatr Urol. 2020 Aug;16(4):473.e1-473.e9. doi: 10.1016/j.jpurol.2020.05.158. Epub 2020 May 29.
Accurate diagnosis of distant metastasis especially uncommon site of metastasis (UCM) in patients with Wilms tumor (WTs) is a demanding prerequisite for administration of appropriate therapy and achieving better survival outcome.
To develop and validate a nomogram to predict probability of distant metastasis, and identify population demanded for rigorous imaging evaluations in children with WTs.
Data of patients diagnosed with unilateral WTs and aged under 18 years old, were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The included patients were randomly allocated to the training and the validation cohort. Logistic regression analyses were performed to identify the independent risk factors and develop a predicting model of distant metastasis in WTs. The model-based nomogram was created and internally validated. Cut-off value of nomogram points was derived by using the receiver operating characteristics (ROC) curve analysis. Performance of the nomogram was evaluated in terms of discrimination, calibration and clinical usefulness.
A total 717 WTs patients were included in the study. Age at diagnosis (OR 1.173, 95%CI: 1.079-1.279), LND (OR 8.260, 95%CI: 2.837-24.814) and tumor size (OR 2.141, 95%CI: 1.378-3.329) were identified as the independent risk factors of distant metastasis in WTs. These three factors were incorporated to develop a model and a nomogram. The nomogram presented with good discriminative ability in the training cohort (C-statistics, 0.703) and validation cohort (C-statistics, 0.764), respectively. The calibration curves demonstrated adequate agreement between predicted probability and observed probability of distant metastasis. The nomogram also revealed its clinical usefulness by application of decision curve analysis (DCA). Cut-off value of nomogram points was 58 and its corresponding probability of distant metastasis was 0.22. The value was applied in risk stratification dividing the general cohort into high-risk and low-risk group.
Our study for the first time developed and validated a model and a visualized nomogram for individualized prediction of distant metastasis in WTs. C-statistics, calibration curves and DCA demonstrated good performance and clinical usefulness of the nomogram. Patients stratified as high-risk group were demanded for rigorous imaging evaluations to accurately identify UCM.
The nomogram, developed by incorporation of three independent risk factors, which are age at diagnosis, LND and tumor size, is used to facilitate individualized prediction of distant metastasis in WTs. Rigorous imaging evaluations are recommended for patients in high-risk group to identify UCM.
准确诊断 Wilms 瘤（WTs）患者的远处转移，尤其是罕见转移部位（UCM），是为患者提供适当治疗并获得更好生存结果的必要前提。
开发并验证一个列线图，以预测远处转移的概率，并确定在患有 WTs 的儿童中需要进行严格影像学评估的人群。
从监测、流行病学和最终结果（SEER）数据库中提取诊断为单侧 WTs 且年龄在 18 岁以下的患者数据。将纳入的患者随机分配到训练和验证队列中。使用逻辑回归分析确定远处转移的独立危险因素，并建立 WTs 远处转移预测模型。创建并内部验证模型基础列线图。通过接收者操作特征（ROC）曲线分析得出列线图点的截断值。使用判别、校准和临床实用性评估列线图的性能。
共纳入 717 例 WTs 患者。诊断时的年龄（OR 1.173，95%CI：1.079-1.279）、淋巴结清扫术（OR 8.260，95%CI：2.837-24.814）和肿瘤大小（OR 2.141，95%CI：1.378-3.329）被确定为 WTs 远处转移的独立危险因素。这三个因素被纳入模型和列线图的建立中。列线图在训练队列（C 统计量，0.703）和验证队列（C 统计量，0.764）中均具有良好的判别能力。校准曲线表明，预测的远处转移概率与观察到的远处转移概率之间具有良好的一致性。该列线图还通过决策曲线分析（DCA）显示了其临床实用性。列线图点的截断值为 58，对应的远处转移概率为 0.22。该值用于风险分层，将一般队列分为高危组和低危组。
本研究首次开发并验证了一个模型和一个可视化列线图，用于个体化预测 WTs 的远处转移。C 统计量、校准曲线和 DCA 表明，该列线图具有良好的性能和临床实用性。被归类为高危组的患者需要进行严格的影像学评估，以准确识别罕见转移部位。
该列线图由三个独立的危险因素（诊断时的年龄、淋巴结清扫术和肿瘤大小）组成，用于辅助预测 WTs 的远处转移。对于高危组患者，建议进行严格的影像学评估以识别罕见转移部位。
