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Pediatric Surgery International

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01-12-2023 | Neuroblastoma | Original Article

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

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

Published in: Pediatric Surgery International | Issue 1/2023

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.

Matthay KK, Maris JM, Schleiermacher G et al (2016) Neuroblastoma. Nat Rev Dis Primers 2:16078. https://doi.org/10.1038/nrdp.2016.78CrossRefPubMed

Liang WH, Federico SM, London WB et al (2020) Tailoring therapy for children with neuroblastoma on the basis of risk group classification: past, present, and future. JCO Clin Cancer Inform 4:895–905. https://doi.org/10.1200/CCI.20.00074CrossRefPubMed

Whittle SB, Smith V, Doherty E, Zhao S, McCarty S, Zage PE (2017) Overview and recent advances in the treatment of neuroblastoma. Expert Rev Anticancer Ther 17:369–386. https://doi.org/10.1080/14737140.2017.1285230CrossRefPubMed

Barr EK, Laurie K, Wroblewski K, Applebaum MA, Cohn SL (2020) Association between end-induction response according to the revised International Neuroblastoma Response Criteria (INRC) and outcome in high-risk neuroblastoma patients. Pediatr Blood Cancer 67:e28390. https://doi.org/10.1002/pbc.28390CrossRefPubMedPubMedCentral

Ley S, Ley-Zaporozhan J, Günther P, Deubzer HE, Witt O, Schenk JP (2011) Neuroblastoma imaging. Rofo 183:217–225. https://doi.org/10.1055/s-0029-1245903CrossRefPubMed

Brisse HJ, McCarville MB, Granata C et al (2011) Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project. Radiology 261:243–257. https://doi.org/10.1148/radiol.11101352CrossRefPubMed

Charron M (2013) Contemporary approach to diagnosis and treatment of neuroblastoma. Q J Nucl Med Mol Imaging 57:40–52PubMed

Bleeker G, Tytgat GA, Adam JA et al (2015) 123I-MIBG scintigraphy and 18F-FDG-PET imaging for diagnosing neuroblastoma. Cochrane Database Syst Rev 2015:CD00263. https://doi.org/10.1002/14651858.CD009263.pub2CrossRef

Englum BR, Rialon KL, Speicher PJ et al (2015) Value of surgical resection in children with high-risk neuroblastoma. Pediatr Blood Cancer 62:1529–1535. https://doi.org/10.1002/pbc.25504CrossRefPubMed

10.

Braga F, Ferraro S, Mozzi R, Dolci A, Panteghini M (2013) Biological variation of neuroendocrine tumor markers chromogranin A and neuron-specific enolase. Clin Biochem 46:148–151. https://doi.org/10.1016/j.clinbiochem.2012.09.005CrossRefPubMed

11.

Morgenstern DA, London WB, Stephens D et al (2014) Metastatic neuroblastoma confined to distant lymph nodes (stage 4N) predicts outcome in patients with stage 4 disease: a study from the International Neuroblastoma Risk Group Database. J Clin Oncol 32:1228–1235. https://doi.org/10.1200/JCO.2013.53.6342CrossRefPubMedPubMedCentral

12.

Hassan SF, Mathur S, Magliaro TJ et al (2012) Needle core vs open biopsy for diagnosis of intermediate- and high-risk neuroblastoma in children. J Pediatr Surg 47:1261–1266. https://doi.org/10.1016/j.jpedsurg.2012.03.040CrossRefPubMed

13.

Overman RE, Kartal TT, Cunningham AJ et al (2020) Optimization of percutaneous biopsy for diagnosis and pretreatment risk assessment of neuroblastoma. Pediatr Blood Cancer 67:e28153. https://doi.org/10.1002/pbc.28153CrossRefPubMed

14.

Ilivitzki A, Sokolovski B, Assalia A et al (2021) Ultrasound-guided core biopsy for tissue diagnosis in pediatric oncology: 16-year experience with 597 biopsies. AJR Am J Roentgenol 216:1066–1073. https://doi.org/10.2214/AJR.20.23196CrossRefPubMed

15.

Mohamed H, Pastor MC, Langlois S, Cowan KN (2022) Comparing safety and adequacy between surgical biopsy versus core needle biopsy in diagnosing neuroblastoma. J Pediatr Surg 57:866–870. https://doi.org/10.1016/j.jpedsurg.2021.12.032CrossRefPubMed

16.

Monclair T, Brodeur GM, Ambros PF et al (2009) The international neuroblastoma risk group (INRG) staging system: an INRG task force report. J Clin Oncol 27:298–303. https://doi.org/10.1200/JCO.2008.16.6876CrossRefPubMedPubMedCentral

17.

Steyerberg EW, Vergouwe Y (2014) Towards better clinical prediction models: seven steps for development and an ABCD for validation. Eur Heart J 35:1925–1931. https://doi.org/10.1093/eurheartj/ehu207CrossRefPubMedPubMedCentral

18.

Thiesse P, Hany MA, Combaret V, Ranchère-Vince D, Bouffet E, Bergeron C (2000) Assessment of percutaneous fine needle aspiration cytology as a technique to provide diagnostic and prognostic information in neuroblastoma. Eur J Cancer 36:1544–1551. https://doi.org/10.1016/s0959-8049(00)00146-5CrossRefPubMed

19.

Gupta A, Kumar A, Walters S, Chait P, Irwin MS, Gerstle JT (2006) Analysis of needle versus open biopsy for the diagnosis of advanced stage pediatric neuroblastoma. Pediatr Blood Cancer 47:875–879. https://doi.org/10.1002/pbc.20666CrossRefPubMed

20.

Metz T, Heider A, Vellody R et al (2016) Image-guided percutaneous core needle biopsy of soft-tissue masses in the pediatric population. Pediatr Radiol 46:1173–1178. https://doi.org/10.1007/s00247-016-3571-5CrossRefPubMed

21.

Sokolovski B, Scolnik M, Malkin L, Postovsky S, Weyl Ben-Arush M, Ilivitzki A (2021) Ultrasound-guided core biopsy with on-site cytology-immediate diagnosis in pediatric oncology. Diagn Cytopathol 49:817–821. https://doi.org/10.1002/dc.24746CrossRefPubMed

22.

Gauguet JM, Pace-Emerson T, Grant FD et al (2017) Evaluation of the utility of (99m) Tc-MDP bone scintigraphy versus MIBG scintigraphy and cross-sectional imaging for staging patients with neuroblastoma. Pediatr Blood Cancer. https://doi.org/10.1002/pbc.26601CrossRefPubMed

23.

Li C, Zhang J, Chen S et al (2018) Prognostic value of metabolic indices and bone marrow uptake pattern on preoperative 18F-FDG PET/CT in pediatric patients with neuroblastoma. Eur J Nucl Med Mol Imaging 45:306–315. https://doi.org/10.1007/s00259-017-3851-9CrossRefPubMed

24.

Papathanasiou ND, Gaze MN, Sullivan K et al (2011) 18F-FDG PET/CT and 123I-metaiodobenzylguanidine imaging in high-risk neuroblastoma: diagnostic comparison and survival analysis. J Nucl Med 52:519–525. https://doi.org/10.2967/jnumed.110.083303CrossRefPubMed

25.

Zheng C, Liu S, Feng J, Zhao X (2020) Prognostic value of inflammation biomarkers for survival of patients with neuroblastoma. Cancer Manag Res 12:2415–2425. https://doi.org/10.2147/CMAR.S245622CrossRefPubMedPubMedCentral

26.

Hashimoto O, Yoshida M, Koma Y et al (2016) Collaboration of cancer-associated fibroblasts and tumour-associated macrophages for neuroblastoma development. J Pathol 240:211–223. https://doi.org/10.1002/path.4769CrossRefPubMedPubMedCentral

27.

Nallasamy P, Chava S, Verma SS et al (2018) PD-L1, inflammation, non-coding RNAs, and neuroblastoma: immuno-oncology perspective. Semin Cancer Biol 52:53–65. https://doi.org/10.1016/j.semcancer.2017.11.009CrossRefPubMed

28.

Zhao Q, Jin M, Zhang DW et al (2018) Serum Interleukin-6 Level and the rs1800795 polymorphism in its gene associated with neuroblastoma risk in chinese children. Chin Med J (Engl) 131:1075–1078. https://doi.org/10.4103/0366-6999.230719CrossRefPubMed

29.

Gotoh T, Hosoi H, Iehara T et al (2005) Prediction of MYCN amplification in neuroblastoma using serum DNA and real-time quantitative polymerase chain reaction. J Clin Oncol 23:5205–5210. https://doi.org/10.1200/JCO.2005.02.014CrossRefPubMed

30.

Combaret V, Hogarty MD, London WB et al (2009) Influence of neuroblastoma stage on serum-based detection of MYCN amplification. Pediatr Blood Cancer 53:329–331. https://doi.org/10.1002/pbc.22009CrossRefPubMedPubMedCentral

31.

Kojima M, Hiyama E, Fukuba I et al (2013) Detection of MYCN amplification using blood plasma: noninvasive therapy evaluation and prediction of prognosis in neuroblastoma. Pediatr Surg Int 29:1139–1145. https://doi.org/10.1007/s00383-013-3374-9CrossRefPubMed

32.

Shariat SF, Capitanio U, Jeldres C, Karakiewicz PI (2009) Can nomograms be superior to other prediction tools. BJU Int 103:492–495. https://doi.org/10.1111/j.1464-410X.2008.08073.x. (discussion 495-497)CrossRefPubMed

33.

Cohn SL, Pearson AD, London WB et al (2009) The international neuroblastoma risk group (INRG) classification system: an INRG task force report. J Clin Oncol 27:289–297. https://doi.org/10.1200/JCO.2008.16.6785CrossRefPubMedPubMedCentral

34.

Liang SW, Chen G, Luo YG et al (2020) Nomogram for predicting overall survival in children with neuroblastoma based on SEER database. Ann Surg Treat Res 99:118–126. https://doi.org/10.4174/astr.2020.99.2.118CrossRefPubMedPubMedCentral

35.

Man S, Yan J, Li J et al (2021) Value of pretreatment 18F-FDG PET/CT in prognosis and the reflection of tumor burden: a study in pediatric patients with newly diagnosed neuroblastoma. Int J Med Sci 18:1857–1865. https://doi.org/10.7150/ijms.58263CrossRefPubMedPubMedCentral

36.

Sokol E, Desai AV, Applebaum MA et al (2020) Age, diagnostic category, tumor grade, and mitosis-karyorrhexis index are independently prognostic in neuroblastoma: an INRG project. J Clin Oncol 38:1906–1918. https://doi.org/10.1200/JCO.19.03285CrossRefPubMedPubMedCentral

37.

Qi Y, Zhan J (2021) Roles of surgery in the treatment of patients with high-risk neuroblastoma in the children oncology group study: a systematic review and meta-analysis. Front Pediatr 9:706800. https://doi.org/10.3389/fped.2021.706800CrossRefPubMedPubMedCentral

Title: A nomogram for the preoperative estimation of neuroblastoma risk despite inadequate biopsy information
Authors: Yingyi Qi
Mengdi Li
Fangyuan Zhao
Wenfan Xue
Wang Qiong
Jianghua Zhan
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Neuroblastoma
Neuroblastoma
Biomarkers
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05370-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background and purpose

Method

Result

Conclusion

Levels of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and purpose

Method

Result

Conclusion

Levels of evidence

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