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Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
A prognostic nomogram for neuroblastoma in children
1Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang, China.
Insights
A new nomogram accurately predicts survival for childhood neuroblastoma patients. This tool offers better prognostic accuracy than existing systems, aiding treatment decisions for high-risk cases.
Area of Science:
- Pediatric Oncology
- Cancer Prognostics
- Biostatistics
Background:
- Neuroblastoma is a common pediatric extracranial solid tumor, representing 7-10% of childhood cancers.
- Accurate prognosis is crucial for optimizing treatment efficacy and minimizing long-term complications in high-risk neuroblastoma patients.
Purpose of the Study:
- To develop and validate a predictive nomogram for estimating the overall survival (OS) of childhood neuroblastoma patients.
- To compare the predictive performance of the developed nomogram against established staging systems.
Main Methods:
- Utilized data from 757 neuroblastoma patients diagnosed between 1986 and 2012 from the TARGET database.
- Employed COX regression analysis to identify risk factors and construct a nomogram for survival prediction.
- Evaluated nomogram precision using concordance index (C-index) and area under the receiver operating characteristic (ROC) curve (AUC) for 3- and 5-year survival.
Main Results:
- Multivariate analysis identified age at diagnosis (>520 days), stage 4 (INSS), and DNA ploidy as independent predictors of OS.
- The nomogram achieved a C-index of 0.704 in the training cohort and 0.672 in the validation cohort.
- The nomogram demonstrated superior predictive power compared to the International Neuroblastoma Staging System (INSS), tumor histology, and Children's Oncology Group (COG) risk group.
Conclusions:
- The developed nomogram provides a more accurate prognostic tool for childhood neuroblastoma than current systems.
- Precise survival estimates from this nomogram can significantly aid clinicians in making informed treatment decisions.
- This tool has the potential to improve outcomes for children diagnosed with neuroblastoma.
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.
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