Zhang Chenglong,Wang Xiaoyu,Niu Huizhong,et al.Prognostic value of systemic immune-inflammation index plus International Neuroblastoma Risk Group stratification in neuroblastoma[J].Journal of Clinical Pediatric Surgery,2026,(03):256-262.[doi:10.3760/cma.j.cn101785-20250104]
系统免疫炎症指数联合INRG危险度分级在神经母细胞瘤中的预后价值分析
- Title:
- Prognostic value of systemic immune-inflammation index plus International Neuroblastoma Risk Group stratification in neuroblastoma
- Keywords:
- Neuroblastoma; Immunity; Humoral; Inflammation Mediators; Risk Assessment; Child
- 摘要:
- 目的 神经母细胞瘤(neuroblastoma,NB)是儿童常见的实体肿瘤,低中危患儿生存率已有改善,但高危患儿预后仍较差。研究表明,系统性炎症标志物在肿瘤预后评估中具有重要价值。本研究旨在评估系统免疫炎症指数(systemic immune-inflammation index,SII)对神经母细胞瘤患儿预后的预测价值,并探讨其与INRG(International Neuroblastoma Risk Group)危险度分级联合应用时对预后预测的潜在作用。方法 本研究为回顾性分析,纳入2013年1月至2024年11月在河北省儿童医院确诊的166例神经母细胞瘤患儿。所有患儿均接受肿瘤根治切除术并具有完整的术前血液成分及随访数据。术前血液指标包括中性粒细胞、淋巴细胞和血小板水平,计算得出SII。通过受试者操作特征(receiver operating characteristic,ROC)曲线评估SII与死亡和疾病进展的关系,Kaplan-Meier生存曲线分析验证其预后价值,并通过单因素和多因素Cox回归分析进一步验证其预后作用。结果 SII在预测死亡和疾病进展的ROC曲线下面积为0.89和0.82。高SII组(67例)患儿5年总生存期(overall survival,OS)为54.91%,显著低于低SII组(95.31%,P<0.001);5年无事件生存期(event-free survival,EFS)为41.32%,亦显著低于低SII组(90.37%,P<0.001)。Cox回归分析显示,高SII是患儿总生存期缩短的独立危险因素(HR=19.70,P<0.001),且与疾病进展风险显著相关(HR=4.66,P<0.01)。SII与INRG联合分级后,高危组OS风险比提升至36.19(P<0.001),预测性能优于单一指标。结论 新预后指标"SII+INRG分级"能够有效预测死亡和复发风险,为神经母细胞瘤患儿的个性化治疗提供支持。
- Abstract:
- Objective Neuroblastoma (NB) is a common solid tumor in children.While survival rates for low/intermediate-risk cohorts have improved,the prognosis for high-risk individuals remains poor.Previous studies have demonstrated that systemic inflammatory markers play an important role in assessing tumor prognosis.This study was intended to evaluate the prognostic value of Systemic Immune-Inflammation Index (SII) in NB children and explore the potential role of combining SII with International Neuroblastoma Risk Group (INRG) stratification in improving prognostic prediction.Methods For this retrospective study,166 NB children were recruited from Hebei Childrens Hospital between January 2013 and November 2024.All of them underwent radical tumor resection.And complete preoperative blood component data and follow-up records were available.Preoperative blood parameters,including neutrophil,lymphocyte and platelet counts,were employed for calculating SII.Receiver operating characteristic (ROC) curve analysis was performed for assessing the relationship between SII and both mortality and disease progression.Kaplan-Meier survival analysis was utilized for validating its prognostic value.And univariate and multivariate Cox regression analyses were conducted for further evaluating its prognostic role.Results The area under the ROC curve (AUC) of SII for predicting mortality and disease progression was 0.89 and 0.82,respectively.The high-SII group (n=67) had a 5-year overall survival (OS) rate of 54.91% and it was significantly lower than that of low-SII group (95.31%,P<0.001).The 5-year event-free survival (EFS) rate was 41.32% in high-SII group and it was also significantly lower than that of low-SII group (90.37%,P<0.001).Cox regression analysis revealed that high SII was an independent risk factor for shortened OS (HR=19.70,P<0.001) and it was significantly associated with an elevated risk of disease progression (HR=4.66,P<0.01).When combining SII and INRG stratification,hazard ratio for OS spiked to 36.19 in high-risk group (P<0.001),demonstrating better predictive performance than either indicator alone.Conclusions The new prognostic indicator "SII+INRG stratification" effectively predicts the risk of mortality and recurrence,providing support for personalized treatment strategies in NB children.
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备注/Memo
收稿日期:2025-1-11。
基金项目:河北省卫生健康委员会医学科学研究项目计划(20220039)
通讯作者:耿建磊,Email:genglei653@163.com