基于SEER数据库分析原发于肾上腺的神经母细胞瘤患儿的预后

Prognosis of children with primary adrenal neuroblastoma based on SEER database

目的:探讨原发部位位于肾上腺是否可以作为判断神经母细胞瘤(neuroblastoma,NB)患儿预后的危险因素。方法:回顾分析监测、流行病学和最终结果(Surveillance,Epidemiology and End Results,SEER)数据库2000至2019年14岁以下NB患儿的资料,根据原发部位是否位于肾上腺分为肾上腺组和非肾上腺组,采用倾向评分匹配(propensity score matching,PSM)平衡各组间的基线特征,并使用单因素χ^(2)检验进行组间比较。采用Kaplan-Meier法绘制2组的肿瘤特异性生存期(cancer-specific survival,CSS)和总生存期(overall survival,OS)曲线,log-rank法进行组间比较。采用单因素及多因素Cox分析影响预后的危险因素,随后根据这些因素使用R软件构建预测模型,并应用受试者操作特征(receiver operating characteristic,ROC)曲线、校正曲线及临床决策曲线分析(decision curve analysis,DCA)评价此模型的预测性能。结果:肾上腺组患儿的CSS和OS(P=0.004)均短于非肾上腺组患儿(均P<0.005)。年龄≥1岁、原发部位位于肾上腺、SEER分期为远处转移、未手术治疗、化学治疗均是影响患儿CSS和OS的危险因素(均P<0.05)。根据这些因素成功构建预测模型,通过ROC曲线、校正曲线及DCA曲线验证了该模型能够较准确地预测患儿预后。结论:肾上腺组患儿的预后生存时间短于非肾上腺组患儿,原发于肾上腺是影响预后的危险因素,因此在进行NB危险度分组和治疗时应考虑肿瘤原发部位是否位于肾上腺这一因素。

Objective:To explore whether the primary site of adrenal gland can be used as a risk factor to judge the prognosis of neuroblastoma(NB).Methods:From 2000 to 2019,the data of NB children under the age of 14 in Surveillance,Epidemiology and End Results(SEER)database were retrospectively analyzed.They were divided into an adrenal group and a non-adrenal group according to whether the primary site was located in the adrenal gland.Baseline characteristics between the 2 groups were balanced using propensity score matching and the univariateχ^(2) test was used for comparison between the 2 groups.The Kaplan-Meier method was used to draw the cancerspecific survival(CSS)and overall survival(OS)curves of the 2 groups,and the logrank method was used for comparison between the 2 groups.Univariate and multivariate Cox analysis was used to analyze the prognostic variables.Then,according to these factors,R software was used to construct a prediction model,and the predictive performance of this model was evaluated by using the receiver operating characteristic curve,correction curve and clinical decision curve analysis(DCA).Results:The CSS and OS in the adrenal group was shorter than that in the non-adrenal group(both P<0.005).Age more than or equal to 1-year,primary site located in adrenal gland,SEER stage of distant metastasis,no surgical treatment and chemotherapy were risk factors for prognosis(all P<0.05).According to these factors,the prediction model was successfully constructed,and the ROC curve,correction curve,and DCA curve were used to verify that the prediction model could accurately predict the prognosis of children.Conclusion:The prognosis survival time of children in the adrenal group is shorter than that in the non-adrenal group.The primary site in adrenal gland is a risk factor affecting the prognosis.Therefore,whether the primary site of the tumor is located in the adrenal gland should be considered when making the risk grouping and treatment of NB.