Li Jiayi,Li Zonghan,Fang Yiwei,et al.Development of a preoperative imaging-based predictive model for nephron-sparing surgery feasibility in pediatric bilateral Wilms tumor and comparative evaluation of multiscore systems[J].Journal of Clinical Pediatric Surgery,,():916-922.[doi:10.3760/cma.j.cn101785-202501058-003]
Development of a preoperative imaging-based predictive model for nephron-sparing surgery feasibility in pediatric bilateral Wilms tumor and comparative evaluation of multiscore systems
- Keywords:
- Wilms Tumor; Nephron-sparing Surgery; Prediction Model; Evaluation Study; Comparative Study
- Abstract:
- Objective To construct a clinical prediction model for the feasibility of nephron-sparing surgery (NSS) in children with bilateral Wilms tumor (BWT) based upon preoperative imaging data and compare it with existing adult renal tumor preoperative scoring systems. Methods A retrospective analysis was conducted for the clinical and imaging data of surgical BWT children from 2008 to 2024.A total of 121 renal units from 61 children were included (99 in NSS group and 22 in non-NSS group).Preoperative imaging features were extracted and univariate and multivariate Logistic regression analyses performed for identifying the factors associated with the feasibility of NSS.A prediction model was constructed and evaluated using area under receiver operating characteristic curve (AUC),calibration curve and decision curve.The model was compared with R.E.N.A.L,PADUA and SPARE scoring systems. Results Multivariate Logistic regression analysis identified tumor maximum diameter (OR=0.651,95%CI:0.476-0.891,P=0.007) and relationship with collecting system (OR=0.037,95%CI:0.006-0.220,P=0.001) as independent predictors of NSS feasibility.RSR (relation-size-remaining renal parenchyma) model,based upon tumor size (S),relationship with collecting system (R) and remaining renal parenchyma (R),achieved an AUC of 0.957 (95%CI: 0.924-0.989),demonstrating good predictive capability and clinical applicability.As compared with adult scoring systems,RSR model had demonstrated significantly higher AUC values than R.E.N.A.L (0.778),PADUA (0.828) and SPARE (0.805).And decision curve analysis revealed greater clinical net benefit. Conclusions As the first prediction model for NSS feasibility in BWT children,RSR model offers strong targeting,simplified evaluation criteria and high predictive accuracy.It may serve as a reference for defining the indications for NSS in BWT children.
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Memo
收稿日期:2025-1-20。
基金项目:北京市科委、中关村管委会"医药创新品种及平台培育"专项资助(Z231100004823034)
通讯作者:宋宏程,Email:songhch1975@126.com;李振武,Email:omally@126.com