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Identifying predictive factors for recurrence risk in pediatric craniopharyngioma after surgery using a clinical
1Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring Road West, Fengtai District, Beijing, China.
Insights
This study introduces a new nomogram to predict recurrence in pediatric craniopharyngioma (CP) patients. The tool identifies key risk factors like tumor size and visual disturbances, aiding in personalized patient management.
Area of Science:
- Oncology
- Pediatric Neurosurgery
- Medical Informatics
Background:
- Craniopharyngioma (CP) are WHO grade I tumors with high survival rates in pediatric patients but significant quality of life concerns.
- Postoperative pediatric craniopharyngioma (CO-CP) patients face risks of tumor recurrence, necessitating accurate predictive tools.
- Current risk stratification for CO-CP recurrence requires enhancement for improved patient outcomes.
Purpose of the Study:
- To develop and validate a novel nomogram for predicting recurrence risk in postoperative pediatric craniopharyngioma patients.
- To identify and quantify significant risk factors associated with CO-CP recurrence.
- To provide a graphical tool for clinicians to assess individual patient recurrence probabilities.
Main Methods:
- Retrospective analysis of 192 CO-CP patients treated between January 2012 and July 2019.
- Patients were divided into training (n=115) and internal test (n=77) cohorts using random sampling.
- LASSO regression identified risk factors; nomogram accuracy was assessed via ROC curves and DCA.
Main Results:
- Tumor diameter (OR=9.22), visual disturbances (OR=4.13), preoperative neuroendocrine impairment (OR=2.45), and extent of resection (OR=0.27 for gross-total resection) were significant risk factors.
- The nomogram achieved areas under the ROC curve of 0.777 (training) and 0.766 (internal test).
- Clinical DCA demonstrated the nomogram's utility across a range of probability thresholds.
Conclusions:
- The developed nomogram accurately predicts recurrence risk in postoperative pediatric craniopharyngioma patients.
- Incorporating LASSO-selected endocrinological variables, the nomogram offers a practical tool for risk identification.
- This tool builds upon existing classifications and aids in proactive patient management for improved quality of life.
Background:
Craniopharyngioma (CP) tumors are histologically benign (WHO grade I) and can occur at any age. Postoperative pediatric craniopharyngioma (CO-CP) patients have a high long-term survival rate but are at risk of poor quality of life. In this study, we propose a novel nomogram that graphically expresses the numerical relationship between patients with postoperative CO-CP and risk factors for recurrence.
Methods:
A retrospective analysis was conducted on data from 192 patients treated at XXX Hospital between January 2012 and July 2019. Utilizing R software, a random sampling method was employed to select 115 patients (3/5) for the training cohort and 77 patients (2/5) for the internal test cohort. LASSO regression analysis identified significant risk factors for recurrence, leading to the construction of a nomogram based on these factors. The accuracy of the nomogram was evaluated using receiver operating characteristic (ROC) curves and clinical decision curve analysis (DCA).
Results:
The analysis revealed that tumor diameter was the most significant risk factor for recurrence in post-operative CO-CP patients (95% CI 2.72-35.01, OR = 9.22). Other notable risk factors included visual disturbances (95% CI 0.98-17.35, OR = 4.13), preoperative neuroendocrine function impairment scoring (95% CI 0.76-8.37, OR = 2.45), and the extent of resection (gross-total resection: 95% CI 0.08-0.86, OR = 0.27). The ROC analysis indicated areas under the curve of 0.777 and 0.766 for the training and internal test cohorts, respectively. The clinical DCA curves associated with the nomogram in the training and internal test cohorts ranged from 2 to 78% and 1%-80%, respectively.
Conclusions:
Our proposed nomogram accurately predicts risk factors for postoperative CO-CP recurrence. By incorporating LASSO-selected endocrinological variables, it builds on prior classifications such as Puget et al. (2007) and may serve as a practical tool for identifying patients at increased risk of recurrence.
