Abstract
This study aims to develop and validate a novel prognostic model to estimate overall survival (OS) in nasopharyngeal carcinoma (NPC) patients based on clinical features and blood biomarkers. We assessed the model's incremental value to the TNM staging system, clinical treatment, and Epstein‐Barr virus (EBV) DNA copy number for individual OS estimation. We retrospectively analyzed 519 consecutive patients with NPC. A prognostic model was generated using the Lasso regression model in the training cohort. Then we compared the predictive accuracy of the novel prognostic model with TNM staging, clinical treatment, and EBV DNA copy number using concordance index (C‐index), time‐dependent ROC (tdROC), and decision curve analysis (DCA). Subsequently, we built a nomogram for OS incorporating the prognostic model, TNM staging, and clinical treatment. Finally, we stratified patients into high‐risk and low‐risk groups according to the model risk score, and we analyzed the survival time of these two groups using Kaplan–Meier survival plots. All results were validated in the independent validation cohort. Using the Lasso regression, we established a prognostic model consisting of 13 variables with respect to patient prognosis. The C‐index, tdROC, and DCA showed that the prognostic model had good predictive accuracy and discriminatory power in the training cohort than did TNM staging, clinical treatment, and EBV DNA copy number. Nomogram consisting of the prognostic model, TNM staging, clinical treatment, and EBV DNA copy number showed some superior net benefit. Based on the model risk score, we split the patients into two subgroups: low‐risk (risk score ≤ −1.423) and high‐risk (risk score > −1.423). There were significant differences in OS between the two subgroups of patients. Similar results were observed in the validation cohort. The proposed novel prognostic model based on clinical features and serological markers may represent a promising tool for estimating OS in NPC patients.
Highlights
This study aims to develop and validate a novel prognostic model to estimate overall survival (OS) in nasopharyngeal carcinoma (NPC) patients based on clinical features and blood biomarkers
346 eligible patients were analyzed in the training cohort, and 173 patients were included in the validation cohort
We successfully established a novel prognostic model based on clinical features and blood biomarkers of NPC for individualized prediction of the OS
Summary
This study aims to develop and validate a novel prognostic model to estimate overall survival (OS) in nasopharyngeal carcinoma (NPC) patients based on clinical features and blood biomarkers. TNM staging has some limitations in predicting the survival rate of patients with NPC or in guiding treatments. This because the system is entirely based on the anatomical range of the existing tumors, not on the intrinsic biological heterogeneity of tumors [5]. Many biomarkers, such as clinical characteristics [6], blood biomarkers [7], and radiomics [8], have been investigated to improve the prognosis prediction and treatment efficiency of NPC. Some models are not widely used in clinical practice, because they are time-consuming, high-cost, carry a high risk of radiation exposure, and are not routine medical examinations in the majority of primary care hospitals
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