Abstract
BackgroundUsing the current tumor lymph node metastasis (TNM) staging system to make treatment decisions and predict survival in patients with nasopharyngeal carcinoma (NPC) lacks sufficient accuracy. Patients at the same stage often have different survival prognoses.MethodsIn the current study 802 NPC patients who underwent concurrent radiotherapy and chemotherapy from January 2010 to December 2014 at Sun Yat-sen University Cancer Center in China were retrospectively assessed. The optimal cut-off points for skeletal muscle index (SMI) and monocyte-to-lymphocyte ratio (MLR) were determined via receiver operating characteristic curves. SMI-MLR (S-M) grade and a nomogram were developed and used as clinical indicators in NPC patients. The consistency index (C-index) and a calibration curve were used to measure the accuracy and discriminative capacity of prediction.ResultsThe predictive performance of S-M grade was better than that of TNM staging (C-index 0.639, range 0.578–0.701 vs. 0.605, range 0.545–0.665; p = 0.037). In multivariate analysis S-M grade, T stage, and N stage were independent prognostic factors. These three factors were then combined, yielding a nomogram with a C-index of 0.71 (range 0.64–0.77), indicating good predictive capacity.ConclusionWe developed and validated a prognostic parameter, S-M grade, which increased prediction accuracy significantly and can be combined with TNM staging to predict survival in patients with NPC undergoing concurrent chemoradiotherapy.
Highlights
Nasopharyngeal carcinoma (NPC) is a common malignant tumor in southern China
Though the tumor lymph node metastasis (TNM) staging system is the most widely used to predict prognosis and guide treatment, it only grades patients based on the degree of lymph node involvement and the size of the tumor, and ignores other important prognostic factors such as nutritional features, treatment-related factors, and inflammation status
The aim of the present study was to construct a practical tool combining skeletal muscle index (SMI), monocyte-to-lymphocyte ratio (MLR), and TNM stage to assess the prognosis of patients with NPC undergoing concurrent chemoradiotherapy (CCRT)
Summary
Nasopharyngeal carcinoma (NPC) is a common malignant tumor in southern China. It differs greatly by ethnicity and geographic distribution, and exhibits diverse histopathology [1,2,3]. Radiotherapy and chemotherapy based on the tumor lymph node metastasis (TNM) staging system are currently recognized as the main treatment methods for locally advanced NPC [5, 6]. To provide the optimal treatment to the patient at the right time, precision medicine has been emphasized for the treatment of disease based on individual differences. Using the current tumor lymph node metastasis (TNM) staging system to make treatment decisions and predict survival in patients with nasopharyngeal carcinoma (NPC) lacks sufficient accuracy. Patients at the same stage often have different survival prognoses
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