A prognostic nomogram for neuroblastoma in children

Abstract

Introduction 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. Material and Methods 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). Results 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), MYCN 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. Conclusions 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.

The Association between Race and Survival among Pediatric Patients with Neuroblastoma in the US between 1973 and 2015

“…Finally, research comparing the survival rates by race among children with common extracranial solid tumors between 1985 and 2005 reported that black children had a 31% higher risk of death compared with white children [10]. Studies that used other databases than SEER reported inconsistent results with regard to an association between race and survival in children with neuroblastoma [8,[12][13][14]. In the early 1970s, DiNicola et al compared the survival rates of 30 white and 15 black children with neuroblastoma treated at the Children's Hospital National Medical Center in Washington DC [14].…”

“…The final adjusted model included age, gender, ethnicity, stage, site, and year of diagnosis. These covariates were identified as being clinically relevant and were sued in previous studies as well [8][9][10][11][12][13][14]. In addition, they were unequally distributed according to the race (Table 1) and the survival.…”

“…Despite racial differences reported in the incidence of neuroblastoma, there is not much research on how race influences survival among children with neuroblastoma [8][9][10][11][12][13][14]. Results in regard differences in survival between white and black patients have been inconsistent [8,[11][12][13][14].…”

“…Results in regard differences in survival between white and black patients have been inconsistent [8,[11][12][13][14]. Whereas some of the previous studies using SEER data revealed a reduced survival in Back patients [10,11], others did not coincide [9,12,14]. A study of 3539 children diagnosed with neuroblastoma and participating in the Children's Oncology Group neuroblastoma biology protocol between 2001 and 2009 showed that compared to whites, blacks had a 1.4-fold risk of death due to neuroblastoma, while Asians and Native Americans had a 1.6 and a 3-fold increased risk, respectively.…”

“…A study of 3539 children diagnosed with neuroblastoma and participating in the Children's Oncology Group neuroblastoma biology protocol between 2001 and 2009 showed that compared to whites, blacks had a 1.4-fold risk of death due to neuroblastoma, while Asians and Native Americans had a 1.6 and a 3-fold increased risk, respectively. While blacks and whites were the most commonly included in studies, studies that also assess Native Americans and Asians [8,9], Hispanics [8,9,12], American Indians and Native Pacific Islanders [9,12] survival in neuroblastoma patients are scarce [8][9][10]12].…”