Development and validation of a nomogram for predicting the survival of patients with non-metastatic nasopharyngeal carcinoma after curative treatment.

Wenhua Liang,Anchuan Li,Xi Yuan,Chong Zhao,Yaxiong Zhang,Guanzhu Shen,Hongyun Zhao,Gang Chen,Peiyu Huang,Xuan Wu,Yan Huang,Li Zhang,Shiyang Kang,Yang Li,Ying Tian,Xue Hou

doi:10.1186/s40880-016-0160-9

Abstract

BackgroundThe TNM staging system is far from perfect in predicting the survival of individual cancer patients because only the gross anatomy is considered. The survival rates of the patients who have the same TNM stage disease vary across a wide spectrum. This study aimed to develop a nomogram that incorporates other clinicopathologic factors for predicting the overall survival (OS) of non-metastatic nasopharyngeal carcinoma (NPC) patients after curative treatments.MethodsWe retrospectively collected the clinical data of 1520 NPC patients who were diagnosed histologically between November 2000 and September 2003. The clinical data of a separate cohort of 464 patients who received intensity-modulated radiation therapy (IMRT) between 2001 and 2010 were also retrieved to examine the extensibility of the model. Cox regression analysis was used to identify the prognostic factors for building the nomogram. The predictive accuracy and discriminative ability were measured using the concordance index (c-index).ResultsWe identified and incorporated 12 independent clinical factors into the nomogram. The calibration curves showed that the prediction of OS was in good agreement with the actual observation in the internal validation set and IMRT cohort. The c-index of the nomogram was statistically higher than that of the 7th edition TNM staging system for predicting the survival in both the primary cohort (0.69 vs. 0.62) and the IMRT cohort (0.67 vs. 0.63).ConclusionWe developed and validated a novel nomogram that outperformed the TNM staging system in predicting the OS of non-metastatic NPC patients who underwent curative therapy.

Highlights

The TNM staging system is far from perfect in predicting the survival of individual cancer patients because only the gross anatomy is considered
Nasopharyngeal carcinoma (NPC) is relatively common among patients living in the Far East and their descendants who have migrated abroad [1, 2]
nasopharyngeal carcinoma (NPC) in these populations is associated with Epstein–Barr virus (EBV) infection, which is rare in NPC patients in other parts of the world [3]

Summary

Introduction

The TNM staging system is far from perfect in predicting the survival of individual cancer patients because only the gross anatomy is considered. The survival rates of the patients who have the same TNM stage disease vary across a wide spectrum. This study aimed to develop a nomogram that incorporates other clinicopathologic factors for predicting the overall survival (OS) of non-metastatic nasopharyngeal carcinoma (NPC) patients after curative treatments. Nasopharyngeal carcinoma (NPC) is relatively common among patients living in the Far East and their descendants who have migrated abroad [1, 2]. Radiotherapy remains the backbone of care in non-metastatic NPC patients, along with various combinations with chemotherapy, including induction, concomitant, and adjuvant chemotherapy [4]. A more accurate prediction of the survival is required in clinical practice

Objectives

Methods

Results

Conclusion