Xi Chengjun,Yang Chao.Prognostic value of fibrinogen-to-albumin ratio in children with neuroblastoma[J].Journal of Clinical Pediatric Surgery,2026,(04):323-332.[doi:10.3760/cma.j.cn101785-20260107-00009]
纤维蛋白原与白蛋白比值预测儿童神经母细胞瘤预后的意义探讨
- Title:
- Prognostic value of fibrinogen-to-albumin ratio in children with neuroblastoma
- Keywords:
- Neuroblastoma; Fibrinogen-to-albumin Ratio; Nomograms; Prognosis; Overall Survival; Child
- 摘要:
- 目的 探讨术前纤维蛋白原与白蛋白比值(fibrinogen-to-albumin ratio,FAR)对神经母细胞瘤(neuroblastoma,NB)预后评估的价值。方法 本研究为回顾性队列研究。收集2014年1月至2025年1月重庆医科大学附属儿童医院收治的279例NB患儿临床资料,按7[KG0.5mm]∶3比例(随机数字表法)分为训练集(n=195)和验证集(n=84)。采用受试者操作特征(receiver operator characteristic,ROC)曲线确定FAR的最佳截断值;采用单因素及多因素Cox比例风险回归模型筛选总体生存期(overall survival,OS)的独立预后因素,并构建列线图;采用一致性指数(C-index)、时间依赖性ROC曲线、校准曲线及决策曲线分析法(decision curve analysis,DCA)评估模型的预测性能。结果 ROC曲线分析显示,FAR预测NB预后的最佳截断值为0.0734[受试者操作特征曲线下面积(area under the receiver operating characteristic curve,AUC)为0.772)]。多因素Cox回归分析显示,年龄≥18个月、MYCN基因扩增、国际神经母细胞瘤风险协作组(International Neuroblastoma Risk Group,INRG)分期为M期以及高FAR是OS缩短的独立危险因素。基于上述因素构建列线图,训练集模型预测3年、5年OS的AUC分别为0.812、0.869,而验证集分别为0.824、0.846。校准曲线显示,预测值与观测值高度一致;DCA曲线证实,该模型具有良好的临床净获益。基于模型评分的风险分层可显著区分不同预后人群(P<0.001)。结论 术前FAR是NB患儿预后的独立预测因子。本研究构建的包含FAR的列线图模型具有良好的区分度、校准度和临床实用性,有助于实现NB患儿的个体化预后评估。
- Abstract:
- Objective To explore the prognostic value of preoperative fibrinogen-to-albumin ratio (FAR) in children with neuroblastoma (NB).Methods Between January 2014 and January 2025,retrospective analysis was conducted for the relevant clinical data of 279 NB children.They were randomized into two cohorts of training (n=195) and validation (n=84).The optimal cutoff value for FAR was determined by receiver operating characteristic (ROC) curve analysis.Univariate and multivariate Cox proportional hazards regression models were utilized for identifying independent prognostic factors and subsequently used for constructing a nomogram.The predictive performance of the model was evaluated via concordance index (C-index),time-dependent ROC curve,calibration curve and decision curve analysis (DCA).Results The optimal cutoff value of FAR for prognostic prediction was 0.0734.Multivariate Cox regression analysis revealed that age ≥18 month,MYCN amplification,INRG stage M and a high FAR were independent risk factors for OS in NB children.The areas under the curve (AUCs) of nomogram for predicting 3/5-year OS were 0.812 and 0.869 in training cohort and 0.824 and 0.846 in validation cohort.Calibration curve demonstrated strong consistency between predicted and observed survival probabilities,and DCA confirmed the model’s substantial clinical net benefit.Furthermore,risk stratification based upon the nomogram scores successfully discriminated children with different survival outcomes (P<0.001).Conclusions Preoperative FAR serves as an independent prognostic predictor for NB children.And FAR-incorporated nomogram exhibits excellent discrimination,calibration and clinical utility,facilitating individualized prognostic assessments for NB children.
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备注/Memo
收稿日期:2026-1-7。
通讯作者:杨超,Email:400843@hospital.cqmu.edu.cn