Residual Volume of Lymph Nodes During Chemoradiotherapy Based Nomogram to Predict Survival of Nasopharyngeal Carcinoma Patient Receiving Induction Chemotherapy

Abstract

PurposeTo accurately stratify nasopharyngeal carcinoma (NPC) patients who were benefit from induction chemotherapy (IC) followed by chemoradiotherapy (CCRT), we established residual volume of lymph nodes during chemoradiotherapy based nomogram to predict survival for NPC patients.MethodsCox regression analysis were used to evaluate predictive effects of tumor volume parameters. Multivariate Cox regression analysis was used to identify the prognostic factors, and nomogram models were developed to predict survival of NPC patients receiving IC followed by CCRT.ResultsCompared with other tumor volumetric parameters, midRT GTVnd was the best predictive factor for OS (HR: 1.043, 95%CI: 1.031-1.055), PFS (HR: 1.040, 95%CI: 1.030- 1.051), and DMFS (HR: 1.046, 95%CI: 1.034 – 1.059) according to the HR of Cox regression analysis. Based on multivariate analysis, three nomograms included midRT GTVnd were constructed to predict 4-year survival. The C-index of nomograms for each survival endpoints were as follow (training cohort vs. validation cohort): 0.746 vs. 0.731 for OS; 0.747 vs. 0.735 for PFS; 0.768 vs. 0.729 for DMFS, respectively. AUC showed a good discriminative ability. Calibration curves demonstrated a consistence between actual results and predictions. Decision curve analysis (DCA) showed that the nomograms had better clinical predictive effects than current TNM staging system.ConclusionWe identified the best volumetric indicator associated with prognosis was the residual volume of lymph nodes at the fourth week of chemoradiotherapy for patients receiving IC followed by CCRT. We developed and validated three nomograms to predict specific probability of 4-year OS, PFS and DMFS for NPC patient receiving IC followed by CCRT.

Therapeutic evaluation of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma with low-risk N stage -a multicenter retrospective study from non-endemic region of China

“…This result suggested that increasing treatment intensity might improve prognosis for elder patient with good status. Our previous study and published studies con rmed that primary tumor volume negatively affected prognosis of NPC [15,19,20]. In this study, IC followed by CCRT signi cantly decreased death risk for patient with primary tumor volume ≦ 52.6cc in subgroup analysis, indicating small primary tumor volume might be easier to achieve better survival bene t from IC followed by CCRT in T3-4 patient.…”

“…Many studies identi ed age was a prognostic factor for poor OS of NPC [15,17,18]. In this study, IC followed by CCRT could signi cantly improve OS in patients with age > 45 year according to subgroup analysis.…”

“…And ethnic origin was different between endemic area and Northwest China [13]. Given the potential differences in histological type, expression of EBV DNA copies and ethnic origin, patients from Northwest China might have different treatment outcomes in spite of they received similar treatment regimen with endemic patients [14,15]. Therefore, it is necessary to evaluate the consistency of study between endemic area and non-endemic area for NPC.…”

Nomograms incorporating primary tumor response at mid‐radiotherapy to predict survival in locoregionally advanced nasopharyngeal carcinoma

“…Such a phenomenon might be associated with individual chemo-and radiosensitivity. 12,21,22 In 2019, Liang et al 23 reported that patients with non-CR of the PT or metastatic lymph nodes at the end of RT had a worse prognosis than those with CR. Unlike their findings, we found that PT regression, but not CLNs regression at mid-RT, plays a critical role in predicting DFS and OS of patients with LA-NPC (Figures 1C,D and 2C,D).…”

A nomogram based on tumor response to induction chemotherapy may predict survival in locoregionally advanced nasopharyngeal carcinoma

“…The current study confirmed the data of previous studies that tumor response has prognostic value for patients with LANPC. Although the tumor regressions during and after radiotherapy were also demonstrated to predict clinical outcomes, and to a certain extent, could represent radiation sensitivity, [27][28][29] early assessment before the implement of radiotherapy can help guide clinicians in choosing more individualized treatment regime in a timely manner.…”