Zhang Jian, Tai Mengqi, Cao Su'e
Department of Pediatrics, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China.
Medicine (Baltimore). 2025 Aug 8;104(32):e43781. doi: 10.1097/MD.0000000000043781.
Lymphoma in children and adolescents represents a distinct clinical entity, often associated with aggressive biological behavior and poor cancer-specific outcomes. Accurate prediction of cancer-specific death (CSD) in this population is essential for guiding personalized treatment and follow-up strategies. This study aimed to develop and validate a nomogram for predicting the risk of CSD in children and adolescents with lymphoma using a competing risk model based on a large population-based cohort. Lymphoma cases diagnosed in patients aged 1 to 17 years were extracted from the surveillance, epidemiology, and end results database. Eligible patients were randomly assigned to a training cohort (70%) and a validation cohort (30%). Independent prognostic factors for CSD were identified using univariate and multivariate competing risk regression analyses. A nomogram was constructed based on significant variables, and its performance was evaluated by the concordance index (C-index), receiver operating characteristic curves, and calibration plots. A total of 6954 pediatric and adolescent lymphoma cases were included. Six variables, including age, race, diagnosis time, lymphoma subtype, tumor grade, and tumor stage, were identified as independent predictors of CSD. The nomogram showed strong discriminative power, with 5-, 10-, and 15-year area under curves of 0.814, 0.794, and 0.787 in the training cohort, 0.818, 0.792, and 0.764 in the validation cohort. Calibration curves demonstrated good agreement between predicted and observed outcomes. Survival analysis showed that patients with high-risk score had a poor clinical outcome. We developed a robust and clinically practical nomogram for predicting CSD in children and adolescents with lymphoma. This tool may assist clinicians in identifying high-risk patients and formulating individualized management strategies.
儿童和青少年淋巴瘤是一种独特的临床实体，常伴有侵袭性生物学行为和较差的癌症特异性预后。准确预测该人群的癌症特异性死亡（CSD）对于指导个性化治疗和随访策略至关重要。本研究旨在基于一个大型人群队列，利用竞争风险模型开发并验证一种用于预测儿童和青少年淋巴瘤患者CSD风险的列线图。从监测、流行病学和最终结果数据库中提取1至17岁患者诊断的淋巴瘤病例。符合条件的患者被随机分配到训练队列（70%）和验证队列（30%）。使用单因素和多因素竞争风险回归分析确定CSD的独立预后因素。基于显著变量构建列线图，并通过一致性指数（C指数）、受试者操作特征曲线和校准图评估其性能。共纳入6954例儿童和青少年淋巴瘤病例。包括年龄、种族、诊断时间、淋巴瘤亚型、肿瘤分级和肿瘤分期在内的六个变量被确定为CSD的独立预测因素。列线图显示出强大的辨别力，训练队列中5年、10年和15年曲线下面积分别为0.814、0.794和0.787，验证队列中分别为0.818、0.792和0.764。校准曲线表明预测结果与观察结果之间具有良好的一致性。生存分析表明，高危评分患者的临床预后较差。我们开发了一种强大且临床实用的列线图，用于预测儿童和青少年淋巴瘤患者的CSD。该工具可帮助临床医生识别高危患者并制定个体化管理策略。
