Abstract
PurposeOur study aimed to establish and validate prognostic nomograms based on gross tumor volume (GTV) and cervical nodal volume (CNV) for nasopharyngeal carcinoma (NPC) patients treated with two cycles of concurrent chemoradiotherapy (CCRT).MethodsFrom 2012 to 2015, 620 eligible patients who received radical treatment at the Cancer Hospital of Shantou University Medical College were recruited for a nomogram study. Variables were determined in a training set of 463 patients from 2012 to 2014 by X-tile analysis, univariate and multivariate Cox proportional hazard analyses, and the least absolute shrinkage and selection operator (LASSO). Another cohort of 157 patients in 2015 was validated with bootstrap resampling. The concordance index (C-index) and calibration curves were applied to assess its predictive discriminative and accuracy ability, while decision curve analysis (DCA), X-tile analysis and Kaplan–Meier curve for clinical application.ResultsIndependent prognostic variables for overall survival (OS) were age, GTV, CNV, cranial nerve, positive cervical lymph node laterality below the caudal border of cricoid cartilage (LNBC), and were selected for the nomogram. Optimal prognostic factors including Karnofsky performance status (KPS), age, GTV, CNV, LNBC were incorporated in the nomogram for progression-free survival (PFS). In the training set, the C-index of our nomograms for OS and PFS were 0.755 (95% CI, 0.704 to 0.807) and 0.698 (95% CI, 0.652 to 0.744). The calibration curve showed good agreement between nomogram-predicted and actual survival. DCA indicated that our nomograms were of clinical benefit.ConclusionOur nomograms are capable of effective prognostic prediction for patients with NPC.
Highlights
nasopharyngeal carcinoma (NPC) is an endemic malignant tumor that has the highest incidence reported in Southern China and Southeast Asia [1]
Optimal prognostic factors including Karnofsky performance status (KPS), age, gross tumor volume (GTV), cervical nodal volume (CNV), LNBC were incorporated in the nomogram for progression-free survival (PFS)
The concordance index (C-index) of our nomograms for overall survival (OS) and PFS were 0.755 and 0.698
Summary
NPC is an endemic malignant tumor that has the highest incidence reported in Southern China and Southeast Asia [1]. The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system is used widely to predict prognosis for NPC. Patients who at the same TNM stages and with identical or similar treatment regimens still have diverse survival rates [4]. This indicates the limitations of TNM staging and shows it is not adequate enough to predict prognosis. There is increasing evidence that GTV [2], CNV [3], Epstein–Barr virus (EBV) DNA copy number [5], tumor-infiltrating lymphocytes (TILs) [6] and lactate dehydrogenase (LDH) [7] are significant prognostic factors that might serve as indicators to develop more effective, accurate and applicable prediction models
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