Abstract
ObjectiveThis study focused on developing an effective nomogram for improving prognostication for patients with primary nasopharyngeal carcinoma (NPC) restaged according to the eighth edition of the AJCC/UICC TNM staging system.MethodsBased on data of 5,903 patients with non-metastatic NPC (primary cohort), we used Cox regression analysis to identify survival risk factors and created a nomogram. We used the nomogram to predict overall survival (OS), distant metastasis-free survival (DMFS) and disease-free survival (DFS) in the primary and independent validation (3,437 patients) cohorts. Moreover, we compared the prognostic accuracy between the 8th TNM system and the nomogram.ResultsThe nomogram included gender, age, T stage, N stage, Epstein–Barr virus DNA, hemoglobin, C-reactive protein, lactate dehydrogenase, and radiotherapy with/without induction or concurrent chemotherapy. In the prediction of OS, DMFS and DFS, the nomogram had significantly higher concordance index (C-index) and area under ROC curve (AUC) than the TNM system alone. Calibration curves demonstrated satisfactory agreements between nomogram-predicted and observed survival. The stratification in different groups permitted remarkable differentiation among Kaplan–Meier curves for OS, DMFS, and DFS.ConclusionThe nomogram led to a more precise prognostic prediction for NPC patients in comparison with the 8th TNM system. Therefore, it could facilitate individualized and personalized patients’ counseling and care.
Highlights
Nasopharyngeal carcinoma (NPC), which arises from the nasopharynx epithelium, is the commonest head and neck malignant tumor in southeastern Asia and southern China (1)
NPC patients were divided into a primary cohort (5,903 patients, about 60% of all data in this study) and a validation cohort
From January 2009 to June 2014, 5,903 primary NPC patients at Sun Yat-sen University Cancer Center were collected in the primary cohort
Summary
Nasopharyngeal carcinoma (NPC), which arises from the nasopharynx epithelium, is the commonest head and neck malignant tumor in southeastern Asia and southern China (1). The risk factors for NPC contain genetic sensitivity, diet, Epstein– Barr virus infection and so on (2, 3). NPC caused 129,079 incident cases as well as triggered 72,987 deaths worldwide in 2018 (4). As for its treatment, radiotherapy is the mainstay therapy for patients with NPC. Combined chemoradiation has better efficaciousness in the therapy in advanced stage of NPC (5). The survival of most NPC patients remains poor. Though patients who were in the same TNM stage and obtained similar treatments, more than 20% of the patients showed poor effect (6), which indicated that therapy failure was partly attributed to the prognostic evaluation of the TNM staging system
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