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A nomogram for the preoperative estimation of neuroblastoma risk despite inadequate biopsy information

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Abstract

Background and purpose

If the preoperative pathological information is inadequate, a risk classification may not be able to be determined for some patients with neuroblastoma. Our objectives were to include imaging factors, serum biomarkers, and demographic factors in a nomogram to distinguish high-risk patients before surgical resection based on the COG classification.

Method

A total of 106 patients were included in the study. Of these, patients with clinicopathologically confirmed neuroblastoma at Tianjin Children's Hospital from January 2013 to November 2021 formed the training cohort (n = 82) for nomogram development, and those patients from January 2010 to December 2013 formed the validation cohort (n = 24) to confirm the model's performance.

Result

On multivariate analysis of the primary cohort, independent factors for high risk were the presence of distant metastasis (p = 0.004), lactate dehydrogenase (LDH) (p = 0.009), and tumor volume (p = 0.033), which were all selected into the nomogram. The calibration curve for probability showed good agreement between prediction by nomogram and actual observation. The C-index of the nomogram was 0.95 95% [0.916–0.99]. Application of the nomogram in the validation cohort still gave good discrimination and good calibration.

Conclusion

Three independent factors including the presence of distant metastasis, lactate dehydrogenase (LDH), and tumor volume are associated with high-risk neuroblastoma and selected into the nomogram. The novel nomogram has the flexibility to apply a clinically suitable cutoff to identify high-risk neuroblastoma patients despite inadequate preoperative pathological information. The nomogram can allow these patients to be offered suitable induction chemotherapy regimens and surgical plans.

Levels of evidence

Level III.

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Abbreviations

C-index:

Concordance Index

CNB:

Core needle biopsy

COG:

Children's oncology group

CT:

Computed tomographic

FNB:

Fine needle biopsy

HR-NB:

High-risk neuroblastoma

IDRFs:

Image-defined risk factors

INPC:

International neuroblastoma staging system

INRG:

International neuroblastoma risk group

INRGSS:

International neuroblastoma risk group staging system

INSS:

International neuroblastoma staging system

MRI:

Magnetic resonance imaging

NB:

Neuroblastoma

NSE:

Neuron-specific enolase

VMA:

Vanillylmandelic acid

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Funding

This study was supported by the grants from the Tianjin Municipal Science and Technology Bureau Major Projects (Grant No. 21ZXGWSY00070) and Tianjin University Children’s Hospital Projects (Grant No. Y2020002).

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Author notes

  1. Yingyi Qi and Mengdi Li have contributed equally to this work.

Authors and Affiliations

  1. Graduate College, Tianjin Medical University, Tianjin, 300070, China

    Yingyi Qi, Mengdi Li, Fangyuan Zhao, Wenfan Xue & Wang Qiong

  2. Department of General Surgery, Tianjin Children’s Hospital, Tianjin, 300134, China

    Yingyi Qi, Mengdi Li, Fangyuan Zhao, Wenfan Xue, Wang Qiong & Jianghua Zhan

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  1. Yingyi Qi
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  2. Mengdi Li
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Contributions

Yingyi Qi and Mengdi Li participated in the experimental design and wrote the main manuscript text, Fangyuan zhao participated in data collection, collation and article revision. Wenfan Xue and Qiong Wang participated in the content review and language revision of the article. Jianghua Zhan guided the research and revised the article. All authors reviewed the manuscript.

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Correspondence to Jianghua Zhan.

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Qi, Y., Li, M., Zhao, F. et al. A nomogram for the preoperative estimation of neuroblastoma risk despite inadequate biopsy information. Pediatr Surg Int 39, 98 (2023). https://doi.org/10.1007/s00383-023-05370-9

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