| Objective: This study aims to compare the application results of INRGSS and INSS in the diagnosis and treatment of pediatric neuroblastoma(NB),and to explore the prognostic value of the two staging systems in pediatric neuroblastoma.Methods: Clinical data,imaging data,diagnosis and treatment protocols,and surgical data of 162 children with NB who was first diagnosed by pathology and/or bone marrow biopsy in Hematology and Oncology Department of Shenzhen Children’s Hospital from January 2010 to June 2021 were retrospectively analyzed.The patients were followed up until December 31,2021 or died.According to the INRGSS and INSS,these patients were reclassified and the stage distribution and prognosis of the two staging systems were compared.Univariate survival analysis was used to screen out the factors affecting the prognosis,and Cox multivariate survival analysis was used to screen the independent prognostic factors.Likelihood Ratio chi-square Test(LRT)and Linear Trend chi-square Test(LTT)were used to compare the homogeneity and discrimination of the two staging systems.-2 Loglikelihood and Concordance Index were used to evaluate the value of the two staging systems predicting prognosis.Results:(1)Univariate analysis shows that: INRGSS,INSS,age,IDRFs ≥ 4,tumors encasing branches of the superior mesenteric artery at the mesenteric root,encasing the origin of the coeliac axis,and/or of the superior mesenteric artery,encasing the iliac vessels,bone marrow metastasis,bone metastasis,distant lymph node metastasis,regional lymph node metastasis and liver metastasis are the related factors affecting the prognosis of children with NB,there were significant differences in 5-year cumulative survival rates(all P<0.05).Multivariate analysis showed that tumors encasing the origin of the coeliac axis,and/or of the superior mesenteric artery,and bone marrow metastasis are independent prognostic factors of NB(P<0.05).(2)According to INRGSS,there were9 cases of L1 stage,50 cases of L2 stage,91 cases of M stage and 12 cases of MS stage.The 5-year cumulative survival rates were 100.0%,91.9%,50.6% and 91.7%,respectively,and the differences between the groups were statistically significant(P <0.05).There were 22 cases of stage 1,12 cases of stage 2,25 cases of stage 3,96 cases of stage 4 and 7 cases of stage 4S with INSS.The 5-year cumulative survival rates were100.0%,100.0%,84.0%,52.9% and 85.7%,respectively,and the differences between the groups were statistically significant(P < 0.05).(3)The Likelihood Ratio chi-square value and Linear Trend chi-square value of INRGSS were both lower than those of INSS(33.291 vs.34.553、10.345 vs.18.162);the-2 Loglikelihood of INRGSS was lower than that of INSS(250.128 vs.273.011),the C index was higher than INSS(0.802 vs.0.788).Conclusions: INRGSS is superior to INSS in predicting the prognosis of NB,and have more advantages in the clinical diagnosis and treatment of NB. |
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