Graduate College, Tianjin Medical University, Tianjin, 300070, China.
Department of General Surgery, Tianjin Children's Hospital, Tianjin, 300134, China.
Pediatr Surg Int. 2023 Feb 1;39(1):98. doi: 10.1007/s00383-023-05370-9.
If the preoperative pathological information is inadequate, a risk classification may not be able to be determined for some patients with neuroblastoma. Our objectives were to include imaging factors, serum biomarkers, and demographic factors in a nomogram to distinguish high-risk patients before surgical resection based on the COG classification.
A total of 106 patients were included in the study. Of these, patients with clinicopathologically confirmed neuroblastoma at Tianjin Children's Hospital from January 2013 to November 2021 formed the training cohort (n = 82) for nomogram development, and those patients from January 2010 to December 2013 formed the validation cohort (n = 24) to confirm the model's performance.
On multivariate analysis of the primary cohort, independent factors for high risk were the presence of distant metastasis (p = 0.004), lactate dehydrogenase (LDH) (p = 0.009), and tumor volume (p = 0.033), which were all selected into the nomogram. The calibration curve for probability showed good agreement between prediction by nomogram and actual observation. The C-index of the nomogram was 0.95 95% [0.916-0.99]. Application of the nomogram in the validation cohort still gave good discrimination and good calibration.
Three independent factors including the presence of distant metastasis, lactate dehydrogenase (LDH), and tumor volume are associated with high-risk neuroblastoma and selected into the nomogram. The novel nomogram has the flexibility to apply a clinically suitable cutoff to identify high-risk neuroblastoma patients despite inadequate preoperative pathological information. The nomogram can allow these patients to be offered suitable induction chemotherapy regimens and surgical plans.
Level III.
如果术前病理信息不足，一些神经母细胞瘤患者可能无法确定风险分类。我们的目标是在 COG 分类的基础上，将影像学因素、血清生物标志物和人口统计学因素纳入列线图，以区分手术切除前的高危患者。
本研究共纳入 106 例患者。其中，2013 年 1 月至 2021 年 11 月在天津市儿童医院经临床病理证实为神经母细胞瘤的患者为列线图开发的训练队列（n=82），2010 年 1 月至 2013 年 12 月的患者为验证队列（n=24），以验证模型的性能。
在主要队列的多变量分析中，远处转移（p=0.004）、乳酸脱氢酶（LDH）（p=0.009）和肿瘤体积（p=0.033）是高危的独立因素，均被选入列线图。概率校准曲线显示列线图预测与实际观察结果具有良好的一致性。列线图的 C 指数为 0.95（95%置信区间：0.916-0.99）。在验证队列中应用该列线图仍然具有良好的区分度和校准度。
有 3 个独立的因素，包括远处转移、乳酸脱氢酶（LDH）和肿瘤体积，与高危神经母细胞瘤相关，并被选入列线图。尽管术前病理信息不足，新的列线图仍具有灵活性，可以应用一个临床合适的切点来识别高危神经母细胞瘤患者。该列线图可以为这些患者提供合适的诱导化疗方案和手术计划。
3 级。
