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

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.