Purpose We aimed to construct of a nomogram to predict progression-free survival (PFS) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC) with risk stratification using computed tomography (CT) radiomics features and clinical factors. Patients and Methods A total of 311 patients diagnosed with LA-NPC (stage III–IVa) at our hospital between 2010 and 2014 were included. The region of interest (ROI) of the primary nasopharyngeal mass was manually outlined. Independent sample t -test and LASSO-logistic regression were used for selecting the most predictive radiomics features of PFS, and to generate a radiomics signature. A nomogram was built with clinical factors and radiomics features, and the risk stratification model was tested accordingly. Results In total, 20 radiomics features most associated with prognosis were selected. The radiomics nomogram, which integrated the radiomics signature and significant clinical factors, showed excellent performance in predicting PFS, with C-index of 0.873 (95% CI: 0.803~0.943), which was better than that of the clinical nomogram (C-index, 0.729, 95% CI: 0.620~0.838) as well as of the TNM staging system (C-index, 0.689, 95% CI: 0.592–0.787) in validation cohort. The calibration curves and the decision curve analysis (DCA) plot obtained suggested satisfying accuracy and clinical utility of the model. The risk stratification tool was able to predict differences in prognosis of patients in different risk categories ( p <0.001). Conclusion CT-based radiomics features, an in particular, radiomics nomograms, have the potential to become an accurate and reliable tool for assisting with prognosis prediction of LA-NPC.

Distant metastasis is the main pattern of treatment failure in nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). We aimed to establish and validate a prognostic nomogram to identify patients with a high risk of distant metastasis. Patients and Methods: A total of 503 patients with nonmetastatic NPC were included in this retrospective study. We established a prognostic nomogram for distant metastasis-free survival (DMFS) based on the Cox proportional hazards model. The predictive discriminative ability and accuracy of the nomogram were assessed with the concordance index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. The nomogram's clinical utility was also evaluated using decision curve analysis (DCA) and Kaplan-Meier method. The predictive ability of the nomogram was validated in an independent cohort. Results:The multivariate analysis showed that circulating CD4 + T lymphocytes, lactate dehydrogenase (LDH), serum ferritin (SF), and N stage were independent prognostic factors for DMFS. Then, we constructed the nomogram based on these factors. The C-indexes of the nomogram for distant metastasis were 0.763 (95% CI: 0.685-0.841) and 0.760 (95% CI: 0.643-0.877) in the training cohort and validation cohort, respectively, which was higher than the 8th TNM staging system (0.672 and 0.677). The calibration curve showed that the prediction results of the nomogram were in high agreement with the actual observation. The ROC curve indicated that the nomogram had a better predictive ability than TNM staging. The DCA also demonstrated that the nomogram was clinically beneficial. In addition, the patients were classified into two different risk groups (high-risk, low-risk) by the nomogram. Conclusion: As a supplement to TNM staging, our nomogram could provide a more effective and accurate prognostic prediction of distant metastasis in NPC patients. It has the potential to guide the individualized treatment of patients to improve their survival.

Purpose:We set out to explore the prognostic value of circulating lymphocyte subsets in patients with nasopharyngeal carcinoma (NPC) before treatment and to investigate changes in lymphocyte subsets resulting from chemoradiotherapy. Patients and Methods: This retrospective study included 677 patients with non-metastatic NPC. The cutoff value of lymphocyte subsets was determined by the receiver operating characteristic curve (ROC), and the prognostic significance of lymphocyte subsets was evaluated by the Log rank test and Cox proportional hazards model. The endpoints were overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS). Differences in lymphocyte subsets before and after chemoradiotherapy were analyzed by Wilcoxon signed rank test. Results: NPC patients with high levels of CD19 + B cells (>9.55%) had better 5-year OS (90.4% VS 76.8%, P < 0.001), 5-year PFS (85.3% VS 71.6%, P < 0.001) and 5-year DMFS (94% VS 86.8%, P = 0.002) than patients with low levels of CD19 + B cells. Patients with high levels of CD4 + T cells (> 37.05%) had better 5-year PFS (83% VS 74.2%, P = 0.015) and better 5-year DMFS (95.8% VS 86.7%, P < 0.001) than those with low levels of CD4 + T cells. Multivariate analyses indicated that CD19 + B cell was an independent prognostic factor for OS, PFS and DMFS in NPC. And CD4 + T cell was an independent prognostic factor for PFS and DMFS. Within 1 month after chemoradiotherapy, the percentages of CD4 + T cells, CD19 + B cells, and the CD4/CD8 ratio decreased significantly, while the percentages of CD8 + T cells increased significantly. Conclusion: NPC patients with low levels of CD19 + B cells or CD4 + T cells before treatment have a poor prognosis. In addition, chemoradiotherapy may reduce the body's immune function in NPC patients.

BackgroundThe 8th edition of AJCC/UICC TNM staging system (TNM system) and the previous nomograms have limitations, therefore we aimed to develop and validate nomograms incorporating routine hematological biomarkers with or without EBV DNA for overall survival (OS) and progression-free survival (PFS). We also evaluated the prognostic role of EBV DNA.Material and Methods1203 patients at our hospital from 2013 to 2016 were retrospectively reviewed and divided into two parts (922 patients for primary cohort and 281 for validation cohort). Nomograms (nomogram with or without EBV DNA) were developed and compared with other models (TNM system alone, TNM system with EBV DNA), via comparison the prognostic role of EBV DNA was evaluated. Internal and external validation were performed. Risk stratification were conducted with recursive partitioning analysis.ResultsThe nomograms with EBV DNA for OS and PFS included sex, age, T category, N category, EBV DNA, albumin, neutrophil to lymphocyte ratio and lactate dehydrogenase. The nomograms without EBV DNA for OS and PFS included the same variables but without EBV DNA. The C-index for nomogram with EBV DNA was 0.715 for OS and 0.705 for PFS. For nomogram without EBV DNA, it was 0.709 and 0.700, respectively. It was 0.639 and 0.636 for TNM system alone and 0.648, 0.646 respectively for TNM system with EBV DNA. The nomograms with or without EBV DNA had better performance than both the TNM system alone and TNM system with EBV DNA, while the TNM system with EBV DNA were better than TNM system alone. The validation cohort indicates great applicability of nomograms. The patients were stratified into 4 risk groups.ConclusionThe nomograms with or without EBV DNA provide better prognostication than the TNM system and also the TNM system with EBV DNA. EBV DNA is valuable in predicting survival, but it is not suggested to incorporate EBV DNA alone to TNM system.

Objective The purpose of this study was to explore the prognostic value of circulating lymphocyte subsets in patients with nasopharyngeal carcinoma (NPC) before treatment and the impact of chemoradiotherapy on lymphocyte subsets. Methods 934 patients with non-metastatic nasopharyngeal carcinoma were analyzed retrospectively. The percentage of circulating lymphocyte subsets was detected by flow cytometry and analyzed retrospectively. The correlation between lymphocyte subsets and prognosis was evaluated by the log-rank test and Cox proportional hazards model, and the differences of lymphocyte subsets before and after chemoradiotherapy was comparing by the paired t-test and Wilcoxon signed rank test. Results Univariate and multivariate analyses indicated that high CD19+ B lymphocytes (HR 0.705, 95%CI 0.519–0.958, P = 0.026) and CD4+ T lymphocytes (HR 0.560, 95%CI 0.331–0.946, P = 0.030) before treatment were independent favorable prognostic factors for overall survival (OS) and distant metastasis-free survival (DMFS) in NPC patients, respectively. After chemoradiotherapy, the percentage of CD3+ T lymphocytes, CD4+ T lymphocytes, CD4/CD8 ratio and CD19+ B lymphocytes decreased significantly, while the percentage of CD8+ T lymphocytes and NK lymphocytes increased significantly. Conclusion Patients with high CD19+B lymphocytes and CD4+T lymphocytes have a better prognosis, and perhaps the immune response can be improved to make the prognosis better by increasing the number of lymphocyte subsets. Chemoradiotherapy may reduce the immune function of patients with nasopharyngeal carcinoma.