A Nomogram for Predicting Cancer-Specific Survival in Children With Wilms Tumor: A Study Based on SEER Database and External Validation in China

Tan, Xiaojie; Wang, Jinkui; Tang, Jie; Tian, Xiaomao; Jin, Liming; Li, Mujie; Zhang, Zhaoxia; He, Dalin

doi:10.3389/fpubh.2022.829840

Cited by 6 publications

(8 citation statements)

References 32 publications

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“…The low level of granularity with respect to sociodemographic factors in SEER also hinders our ability to draw inferences about actionable disparities in WT outcomes. A comparative study of children with WT in China versus the United States between 2004 and 2018 showed that older age was associated with poorer survival only in the United States 34. Congruent with our study’s finding of younger age at diagnosis among AAAP patients (Table 3), the patients in China tended to receive WT diagnosis at a younger age.…”

Section: Discussionsupporting

confidence: 41%

“…Though, management uniformity across populations can be called into question, as the Chinese cohort had less advanced disease, smaller sample size, and shorter follow-up, yet displayed much worse survival. 34 Because of improvement in risk stratification and treatment advances over recent decades, WT has transformed from a disease with dismal recurrence and survival rates to a disease for which long-term cure is common and expected. This study contributes to a growing body of evidence that older age of WT diagnosis is an independent negative prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

“…Congruent with our study’s finding of younger age at diagnosis among AAAP patients (Table 3), the patients in China tended to receive WT diagnosis at a younger age. Though, management uniformity across populations can be called into question, as the Chinese cohort had less advanced disease, smaller sample size, and shorter follow-up, yet displayed much worse survival 34…”

Section: Discussionmentioning

confidence: 99%

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Impact of Age on Overall Survival Among Children With Wilms Tumor

Qian

Sykes-Martin

Tobillo

et al. 2023

American Journal of Clinical Oncology

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Objectives: International trials have reported conflicting findings on whether the association between age and worse overall survival (OS) among children with Wilms tumor (WT) is due to age as an independent prognostic factor or the observation of more advanced disease at older ages. We sought to further elucidate this relationship using a population-based registry analysis. Methods: The Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed with WT under the age of 20. The association between age and OS was assessed using multivariable Cox proportional hazards regression. Results: In this study, 3463 patients (54% female) were diagnosed with WT between 1975 and 2016. More advanced stage, larger primary tumor size, lymph node involvement, disease requiring radiotherapy, and omission of surgery were associated with worse OS (P<0.05). More advanced stage, larger primary tumor size, and disease requiring radiotherapy were also associated with older age, whereas bilateral disease was associated with younger age (P<0.001). On average, each year of age conferred an incremental hazard ratio (HR) of 1.07 (95% CI, 1.01 to 1.12, P=0.018) independent of relevant covariates. The rise in adjusted OS HR was most pronounced after the transitions in diagnosis age from 2 to 3 (HRage 3–15 vs. 0–2 1.77, 95% CI, 1.11 to 2.82, P=0.016) and from 15 to 16 (HRage 16–19 vs. 3–15 2.58, 95% CI, 1.06 to 6.25, P=0.036). Conclusions: Diagnosis of pediatric WT at an older age was found to be independently associated with worse OS. Although additional prospective studies are warranted to examine tumor biology and other potential correlates, more aggressive treatment of older children based on age, especially as they approach early adulthood, may be considered in the multidisciplinary management of WT.

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Section: Discussionsupporting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Age on Overall Survival Among Children With Wilms Tumor

Qian

Sykes-Martin

Tobillo

et al. 2023

American Journal of Clinical Oncology

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“…To aid in this endeavor, prognostic models specific to patients with advanced malignancies receiving palliative RT have emerged [26,27]. Numerous pediatric-specific prognostic models are available for specific malignancies [28–30] and intensive care admissions [31]. We were only able to identify one model for children referred to a palliative care service that was able to predict probability of 60-day survival based on a number of variables [32].…”

Section: Estimating Prognosismentioning

confidence: 99%

Thirty-day mortality as a metric for palliative radiotherapy in pediatric patients

Keit,

Nanda,

Johnstone

2024

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Thirty-day mortality (30DM) is an emerging consideration for determining whether terminally ill adult patients may benefit from palliative radiotherapy (RT). However, the efficacy and ethics of delivering palliative RT at the end of life (EOL) in children are seldom discussed and not well-established. Recent findings Palliative RT is perhaps underutilized among patients ≤21 years old with rates as low as 11%. While effective when delivered early, clinical benefit decreases when administered within the last 30 days of life. Pediatric 30DM rates vary widely between institutions (0.7–30%), highlighting the need for standardized practices. Accurate prognosis estimation remains challenging and prognostic models specific to palliative pediatric patients are limited. Discordance between provider and patient/parent perceptions of prognosis further complicates decision-making. Summary RT offers effective symptom control in pediatric patients when administered early. However, delivering RT within the last 30 days of life may provide limited clinical benefit and hinder optimal EOL planning and care. Early referral for palliative RT, preferably with fewer fractions (five or fewer), along with multidisciplinary supportive care, optimizes the likelihood of maintaining patients’ quality of life. Prognosis estimation remains difficult, and improving patient and family understanding is crucial. Further research is needed to refine prognostic models and enhance patient-centered care.

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“…Studies have shown that clinicopathological factors such as gender, tumor side, tumor size, and surgical approach significantly correlate with the prognosis of elderly patients with RCC (8)(9)(10). Wang et al found that race, tumor histological type, histological grade, T stage, N stage, tumor size, surgery, radiotherapy, and chemotherapy were independent risk factors for distant metastasis of elderly RCC (35,155,365) (11).…”

Section: Introductionmentioning

confidence: 99%

A nomogram for predicting cancer-specific survival and overall survival in elderly patients with nonmetastatic renal cell carcinoma

et al. 2023

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BackgroundRenal cell carcinoma (RCC) is a common malignant tumor in the elderly, with an increasing trend in recent years. We aimed to construct a nomogram of cancer-specific survival (CSS) and overall survival (OS) in elderly patients with nonmetastatic renal cell carcinoma (nmRCC).MethodsClinicopathological information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) program in elderly patients with nmRCC from 2010 to 2015. All patients were randomly assigned to a training cohort (70%) or a validation cohort (30%). Univariate and multivariate Cox regression analyses were used to identify independent risk factors for patient outcomes in the training cohort. A nomogram was constructed based on these independent risk factors to predict the 1-, 3-, and 5-year CSS and OS in elderly patients with nmRCC. We used a range of methods to validate the accuracy and reliability of the model, including the calibration curve, consistency index (C-index), and the area under the receiver operating curve (AUC). Decision curve analysis (DCA) was used to test the clinical utility of the model.ResultsA total of 12,116 patients were enrolled in the study. Patients were randomly assigned to the training cohort (N = 8,514) and validation cohort (N = 3,602). In the training cohort, univariate and multivariate Cox regression analysis showed that age, marriage, tumor histological type, histological tumor grade, TN stage, tumor size, and surgery are independent risk factors for prognosis. A nomogram was constructed based on independent risk factors to predict CSS and OS at 1-, 3-, and 5- years in elderly patients with nmRCC. The C-index of the training and validation cohorts in CSS were 0.826 and 0.831; in OS, they were 0.733 and 0.734, respectively. The AUC results of the training and validation cohort were similar to the C-index. The calibration curve indicated that the observed value is highly consistent with the predicted value, meaning the model has good accuracy. DCA results suggest that the clinical significance of the nomogram is better than that of traditional TNM staging.ConclusionsWe built a nomogram prediction model to predict the 1-, 3- and 5-year CSS and OS of elderly nmRCC patients. This model has good accuracy and discrimination and can help doctors and patients make clinical decisions and active monitoring.

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A Nomogram for Predicting Cancer-Specific Survival in Children With Wilms Tumor: A Study Based on SEER Database and External Validation in China

Cited by 6 publications

References 32 publications

Impact of Age on Overall Survival Among Children With Wilms Tumor

Impact of Age on Overall Survival Among Children With Wilms Tumor

Thirty-day mortality as a metric for palliative radiotherapy in pediatric patients

A nomogram for predicting cancer-specific survival and overall survival in elderly patients with nonmetastatic renal cell carcinoma

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