Abstract
The distant metastasis free survival (DMFS) and overall survival (OS) differ significantly among individuals even within the same clinical stages. The purpose of this retrospective study was to build nomograms incorporating plasma EBV DNA for predicting DMFS and OS of nasopharyngeal carcinoma (NPC) patients after definitive radiotherapy. A total of 1168 non-metastatic NPC patients from two institutions were included to develop the nomograms. Seven and six independent prognostic factors were identified to build the nomograms for OS and DMFS, respectively. The models were externally validated by a separate cohort of 756 NPC patients from the third institutions. For predicting OS, the c-index of the nomogram was significantly better than that of the TNM staging system (Training cohort, P = 0.005; validation cohort, P = 0.03). The c-index of nomogram for DMFS in the training and validation set were both higher than that of TNM classification with marginal significance (P = 0.048 and P = 0.057, respectively). The probability of 1-, 3-, and 5-year OS and DMFS showed optimal agreement between nomogram prediction and actual observation. The proposed stratification of risk groups based on the nomograms allowed significant distinction between Kaplan-Meier curves for survival outcomes. The prognostic nomograms could better stratify patients into different risk groups.
Highlights
overall survival (OS) is very poor[5 ]
The seventh edition of the American Joint Committee on Cancer (AJCC) TNM staging system is the most widely used prognostic tool, in which non-metastatic nasopharyngeal carcinoma (NPC) patients were stratified according to tumor size and invasion, and the extent of lymph node involvement
Attempts are made to reveal the prognostic significance of some laboratory index such as serum C-reactive protein (CRP), lactate dehydrogenase (LDH) and hemoglobulin[8,9]
Summary
OS is very poor[5 ]. The seventh edition of the American Joint Committee on Cancer (AJCC) TNM staging system is the most widely used prognostic tool, in which non-metastatic NPC patients were stratified according to tumor size and invasion, and the extent of lymph node involvement. For patients with equivalent TNM classification, there remains apparently heterogeneity of DMFS and OS6. Plasma EBV DNA copy number is closely related to tumor burden and could serve as a useful prognostic factor in NPC patients with different clinical stages[7]. Nomograms for predicting DMFS and OS after definitive radiotherapy for non-metastatic NPC patients are rare. We hypothesized that nomograms combing T stage, N stage and objective laboratory index could generate more accurate prediction models for curative NPC patients
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