Development and validation of a web‐based calculator to predict individualized conditional risk of site‐specific recurrence in nasopharyngeal carcinoma: Analysis of 10,058 endemic cases

Abstract

BackgroundConditional survival (CS) provides dynamic prognostic estimates by considering the patients existing survival time. Since CS for endemic nasopharyngeal carcinoma (NPC) is lacking, we aimed to assess the CS of endemic NPC and establish a web‐based calculator to predict individualized, conditional site‐specific recurrence risk.MethodsUsing an NPC‐specific database with a big‐data intelligence platform, 10,058 endemic patients with non‐metastatic stage I–IVA NPC receiving intensity‐modulated radiotherapy with or without chemotherapy between April 2009 and December 2015 were investigated. Crude CS estimates of conditional overall survival (COS), conditional disease‐free survival (CDFS), conditional locoregional relapse‐free survival (CLRRFS), conditional distant metastasis‐free survival (CDMFS), and conditional NPC‐specific survival (CNPC‐SS) were calculated. Covariate‐adjusted CS estimates were generated using inverse probability weighting. A prediction model was established using competing risk models and was externally validated with an independent, non‐metastatic stage I–IVA NPC cohort undergoing intensity‐modulated radiotherapy with or without chemotherapy (n = 601) at another institution.ResultsThe median follow‐up of the primary cohort was 67.2 months. The 5‐year COS, CDFS, CLRRFS, CDMFS, and CNPC‐SS increased from 86.2%, 78.1%, 89.8%, 87.3%, and 87.6% at diagnosis to 87.3%, 87.7%, 94.4%, 96.0%, and 90.1%, respectively, for an existing survival time of 3 years since diagnosis. Differences in CS estimates between prognostic factor subgroups of each endpoint were noticeable at diagnosis but diminished with time, whereas an ever‐increasing disparity in CS between different age subgroups was observed over time. Notably, the prognoses of patients that were poor at diagnosis improved greatly as patients survived longer. For individualized CS predictions, we developed a web‐based model to estimate the conditional risk of local (C‐index, 0.656), regional (0.667), bone (0.742), lung (0.681), and liver (0.711) recurrence, which significantly outperformed the current staging system (P < 0.001). The performance of this web‐based model was further validated using an external validation cohort (median follow‐up, 61.3 months), with C‐indices of 0.672, 0.736, 0.754, 0.663, and 0.721, respectively.ConclusionsWe characterized the CS of endemic NPC in the largest cohort to date. Moreover, we established a web‐based calculator to predict the CS of site‐specific recurrence, which may help to tailor individualized, risk‐based, time‐adapted follow‐up strategies.

Nogo-B promotes invasion and metastasis of nasopharyngeal carcinoma via RhoA-SRF-MRTFA pathway

“…Current evaluations of the severity and therapeutic regimen of NPC patients are mainly based on TNM staging from clinical imaging examinations [ 10 ]. Recently, web-based calculators had been used to predict the personalized conditional risk of recurrence in NPC, but the evaluation system remains insufficient to accurately predict the risk of distant metastasis [ 11 ]. Therefore, the underlying mechanisms and potential biomarkers of NPC metastasis need to be identified, hopefully facilitating the prediction of metastasis and prognosis of NPC and even the development of novel therapeutic targets.…”

Metronomic S-1 Adjuvant Chemotherapy Improves Survival in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

“…Introduction Nasopharyngeal carcinoma (NPC) is indeed a type of malignant tumor that originates from the epithelial cells lining the nasopharynx, with the highest incidence rates reported in Southern China and Southeast Asian countries [1]. NPC is characterized by its unique epidemiology, histopathology, and association with Epstein-Barr virus (EBV) infection, and approximately 95% of NPC patients are diagnosed with non-keratinizing pathological subtypes in endemic areas [2]. Approximately 70-80% of patients were diagnosed with locoregionally advanced disease at NPC diagnosis (LANPC) [3].…”

Immune Microenvironment Change and Involvement of Circular RNAs in TIL Cells of Recurrent Nasopharyngeal Carcinoma

“…The preferred treatment for nasopharyngeal carcinoma is radiation therapy. However clinical studies have found that recurrence has become the main cause of treatment failure in nasopharyngeal carcinoma (Liu et al, 2021;Wu et al, 2021). Recent studies have shown that the process of nasopharyngeal carcinogenesis and progression is influenced by the immune microenvironment.…”