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Development and validation of a nomogram for predicting survival in intermediate- and high-risk neuroblastoma of the Children's Oncology Group risk stratification

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Abstract

Purpose

To develop and validate a nomogram for predicting survival in intermediate- and high-risk neuroblastoma patients and to compare the accuracy of the nomogram in predicting survival with Children's Oncology Group (COG) risk stratification.

Methods

A total of 885 intermediate- and high-risk neuroblastoma patients were enrolled in this study, including 243 patients from our hospital (the training set) and 642 patients from the TARGET database (the validation set). The factors related to event-free survival (EFS) and overall survival (OS) in neuroblastoma were determined to construct the nomogram by Cox regression analysis. The C-index, calibration curves, and area under the time-dependent receiver operating characteristic curves (AUCs) were used to assess the predictive performance of the nomogram.

Results

International Neuroblastoma Staging System stage and Mitosis-karyorrhexis index (MKI) were significant unfavorable factors for EFS, while MKI and MYCN status were significant unfavorable factors for OS. The C-index of the nomogram was 0.621 and 0.586 for predicting EFS, 0.650 and 0.570 for predicting OS in the training and validation sets, respectively. The calibration curves revealed good agreement in the EFS and OS predicted by the nomogram. The AUCs of the nomogram for 1-, 2-, 3-year EFS and OS were 0.633, 0.669, 0.604 and 0.672, 0.670, 0.702 in the training set, respectively. Moreover, the nomogram was able to classify patients into two groups according to risk scores, with the “high-risk” group having a lower survival rate than the “intermediate-risk” group. And the nomogram performed better than the COG risk stratification, which had a C-index of 0.537, 0.502 and 0.565, 0.572 for predicting EFS, OS in the training and validation sets, respectively.

Conclusion

We developed and validated a prognostic nomogram for intermediate- and high-risk neuroblastoma patients that clinicians can use to make more informed decisions for individual patients.

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Data availability

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the staff of the Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China for their selfless and valuable assistance. In addition, thanks are due to all the medical researchers and staff who participated in maintaining the TARGET database.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81971642 and 82102088), Capital’s Funds for Health Improvement and Research (No. 2020-2-2025).

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China

    Lijuan Feng, Ying Kan, Wei Wang & Jigang Yang

  2. SinoUnion Healthcare Inc., Beijing, 100192, China

    Chao Wang

  3. Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China

    Hui Zhang

  4. Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, Shijiazhuang, 050051, China

    Peng Xie

Authors
  1. Lijuan Feng
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  2. Ying Kan
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  3. Wei Wang
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  4. Chao Wang
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  5. Hui Zhang
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  6. Peng Xie
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  7. Jigang Yang
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Contributions

JY and PX: conceptualization; LF, YK, and CW: methodology; CW and HZ: software; LF and WW: validation; LF, YK, WW and CW: formal analysis; LF, YK and CW: investigation; LF and YK: data curation; LF, YK, WW, CW, HZ, PX and JY: writing—original draft preparation; LF, YK, WW, CW, HZ, PX and JY: writing—review and editing; LF, HZ and JY: visualization; JY and PX: supervision; HZ and PX: project administration; WW and JY: funding acquisition. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Peng Xie or Jigang Yang.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Beijing Friendship Hospital, Capital Medical University (No. 2020-P2-091-02).

Informed consent

Patient consent was waived due to the retrospective nature of the study. All data used in this manuscript were anonymized.

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Feng, L., Kan, Y., Wang, W. et al. Development and validation of a nomogram for predicting survival in intermediate- and high-risk neuroblastoma of the Children's Oncology Group risk stratification. J Cancer Res Clin Oncol 149, 16377–16390 (2023). https://doi.org/10.1007/s00432-023-05398-3

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  • DOI: https://doi.org/10.1007/s00432-023-05398-3

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