Prognostic Factors and Nomograms to Predict Overall and Cancer-Specific Survival for Children with Wilms' Tumor

Objective. This study is aimed at constructing and verifying nomograms that forecast overall survival (OS) and cancer-specific survival (CSS) of children with Wilms' tumor (WT). Patients and methods. Clinical information of 1613 WT patients who were under 18 years old between 1988 and 2010 was collected from the Surveillance, Epidemiology, and End Results (SEER) database. Using these data, we performed univariate as well as multivariate Cox's regression analyses to determine independent prognostic factors for WT. Then, nomograms to predict 3- and 5-year OS and CSS rates were constructed based on the identified prognostic factors. The nomograms were validated externally and internally. The nomograms' reliability was evaluated utilizing receiver operating characteristic (ROC) curves and concordance indices (C-indices). Results. 1613 WT patients under 18 were involved in the study and randomly divided into the training (n=1210) and validation (n=403) cohorts. Age at diagnosis, tumor laterality, tumor size, tumor stage, and use of surgery were determined as independent prognostic factors for OS and CSS in WT and were further applied to construct prognostic nomograms. The C-index and area under the receiver operating characteristic curve (AUC) revealed the great performance of our nomograms. Internal and external calibration plots also showed excellent agreement between actual survival and nomogram prediction. Conclusion. Precise and convenient nomograms were developed for forecasting OS and CSS of children with WT. These nomograms were able to offer accurate and individualized prognosis and assisted clinicians in performing suitable therapy.