Prognostic Nomogram For Locoregionally Advanced Nasopharyngeal Carcinoma

Abstract

the tnM staging system of npc is the most important model for survival prediction. However, this model does not consider the biological variability of the tumor itself. this study aimed to develop a nomogram for predicting the overall survival of loco-regionally advanced nasopharyngeal carcinoma. 487 Patients with confimed nasopharyngeal carcinoma who underwent IMRT and chemotherapy were included in this study. We established prognostic nomogram for overall survival (oS) based on the cox proportional hazards model. the predictive accuracy and discriminative ability were measured using the concordance index (c-index) and calibration curve. nomogram was validated externally by assessing discrimination and calibration using an independent data set. Continuous net reclassification improvement (nRi) and integrated discrimination improvement (iDi) were used to analyze whether nomogram improve the prediction of survival than tnM stage system. Recursive partitioning analysis (RpA) was performed to stratifying risk of patients. Age, t-stage, n-stage, nLR, LDH were included in the nomogram for OS. The C-index of the nomogram for OS were 0.726 (95% CI, 0.690 to 0.762); The calibration curve showed the nomogram was able to predict 5-year OS accurately. The nomogram had a higher C-index than the TNM stage system (0.726 VS 0.632, P-value < 0.001). The NRI was 0.235 (95% CI: 0.129 to 0.396, P < 0.001), the IDI was 0.079 (95% CI: 0.034 to 0.396, p < 0.001). RPA was performed to stratify patients into three risk group, OS was significantly different between all three risk groups. High risk groups can be benefited survival from adjuvant chemotherapy. The nomogram outperformed the tnM staging system in predicting the oS of loco-regionally advanced nasopharyngeal carcinoma underwent intensity modulated radiation therapy and chemotherapy. Nasopharyngeal carcinoma (NPC) is endemic to the south of China and Asia; an NPC incidence of 2 per million people in China has been reported 1. More than 70% of the newly diagnosed cases are classified as locoregionally advanced disease 2. Concurrent chemoradiotherapy is the standard treatment for locally advanced nasopharyngeal carcinoma 3. However, in some patients, the disease progresses within a few years after chemoradiotherapy. Therefore, identifying a prognostic model for early progression would allow for a better therapeutic plan. The TNM staging system of NPC is the most important model for survival prediction. However, this model does not consider the biological variability of the tumor itself. The prognosis of patients at the same stage receiving the same treatment varies greatly. Therefore, another prognostic model, based on the TNM staging system combined with other prognosis factors, has been evaluated 4 ; however, this model was not validated and has limited clinical applicability. Therefore, in this study, we established and validated a nomogram for locoregionally advanced NPC patients who received intensity-modulated radiation therapy (IMRT) and chemotherapy. Results Baseline chara...

High Pretreatment LDH Predicts Poor Prognosis in Hypopharyngeal Cancer

“…Moreover, longitudinal variation of serum LDH predicted chemotherapy response in metastatic NPC ( 57 ). In addition, prognostic nomogram incorporating LDH and other variables showed satisfactory efficacy in predicting OS of NPC patients ( 58 , 59 ).…”

A Model Combining Skeletal Muscle Mass and a Hematological Biomarker to Predict Survival in Patients With Nasopharyngeal Carcinoma Undergoing Concurrent Chemoradiotherapy

“…The C-index and area under the curve values of S-M grade were higher than those of the current staging system, as was the C-index of the novel nomogram, indicating that the above-described concerns were addressed by the new method. According to reports, CCRT improves the prognosis of stage II-IV NPC patients, and the 5-year OS rate of patients in different centers and stages ranges from 68% to 94.5% (26)(27)(28). In our center, the 1-year, 3-year, and 5-year OS rates of TNM were 98.1% ± 0.98%, 94.4% ± 1.57%, and 91.1% ± 2.35%, respectively.…”

“…In addition, many models were currently being explored and tried to be combined with TNM to improve the performance of patient prognosis prediction. Zhu et al (28) combined the nomogram of age, T stage, N stage, peripheral neutrophillymphocyte ratio, and lactic dehydrogenase to improve the predictive performance, but the number of patients was small. Zheng et al ( 29) study prognostic nomograms based on 9 biomarkers, but these indicators were not routinely measured before treatment, so they are not suitable for wide application.…”

“…According to reports, CCRT improves the prognosis of stage II-IV NPC patients, and the 5-year OS rate of patients in different centers and stages ranges from 68% to 94.5% ( 26 – 28 ). In our center, the 1-year, 3-year, and 5-year OS rates of TNM were 98.1% ± 0.98%, 94.4% ± 1.57%, and 91.1% ± 2.35%, respectively.…”

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“…A growing body of evidence shows that the inflammatory response may contain a momentous part in the progress of tumors [8][9][10][11]. Inflammation factors, such as C-Reactive Protein Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Glasgow Prognostic Score have assessed in multitudinous types of tumors [12][13][14][15][16]. PLR as an indicate of systemic inflammation was linked to worse prognostic for multifarious caners including ovarian cancer, carcinoma of the lungs, and Lower gastrointestinal carcinoma and so on [17][18][19][20].…”