Abstract
BackgroundA higher ratio of pretreatment C-reactive protein/albumin ratio (CAR) is associated with poor prognosis in nasopharyngeal carcinoma (NPC), and Epstein–Barr virus (EBV) DNA level is known to not only participate in the occurrence of nasopharyngeal carcinoma but also affect the development and prognosis of the disease. Herein, we proposed that a combination of both these markers could improve the predictive prognostic ability.MethodsIn all, 842 NPC patients who received concurrent chemoradiotherapy (CCRT) were entered in this study. We collected all patients’ blood samples and EBV DNA copy numbers within one week before any treatment. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off. We employed the Kaplan–Meier method for survival analyses and the univariate and multivariate analyses (Cox proportional hazards regression model) for statistical analysis. A nomogram was constructed based on multivariate analyses results of the validation set. The model was internally validated using 1000 bootstrap samples to avoid overfitting. Another validation of 10-fold cross-validation was also applied. Calibration curves and concordance index (C-index) were calculated to determine predictive and discriminatory capacity.ResultsIn the whole cohort, we observed that higher CAR, EBV DNA level, and CAR-EBV DNA (C-E) grade were associated with shorter overall survival (OS) and distant metastasis-free survival (DMFS) (all P<0.05). In univariate and multivariate analyses, C-E grade was an independent prognostic factor (all P<0.05). In the training set, we gained the similar results with the whole set. According to multivariate analyses of the training set, we constructed a nomogram. The results of bootstrap samples and 10-fold cross-validation showed favorable predictive efficacy. And calibration curves of the model provided credibility to its predictive capability.ConclusionC-E grade was confirmed as an independent prognostic predictor in patients with NPC who received CCRT. Higher level of pretreatment C-E grade could signify a higher risk of metastasis and shorter OS. The prognostic nomogram based on C-E grade was dependable in nasopharyngeal carcinoma patients.
Highlights
Nasopharyngeal carcinoma (NPC) is a relatively rare type of head and neck cancer, and is characterized by its unique ethnic and geographic distributions
According to the maximum Youden index value (Figure 1), the optimal cut-off value for C-reactive protein/albumin ratio (CAR) was 0.537 (AUC: 0.586, 95% CI: 0.512–0.659, P=0.021, sensitivity: 50.00%, specificity: 67.10%) and the optimal cut-off value for Epstein–Barr virus (EBV) DNA level was 2895 (AUC: 0.605, 95% CI: 0.533–0.676, P=0.005, sensitivity: 59.10%, specificity: 61.90%)
We found that CAR and EBV DNA levels were independent predictors of survival in a cohort of NPC patients
Summary
Nasopharyngeal carcinoma (NPC) is a relatively rare type of head and neck cancer, and is characterized by its unique ethnic and geographic distributions. The etiology of NPC is distinct from other carcinomas and is related with the Epstein–Barr virus (EBV) [3]. During the last several decades, patient prognosis has improved dramatically owing to advances in disease management [4]. Clinicians have noticed that the prognosis of different patients with the same TNM staging is quite distinct. One explanation for this is that the TNM staging system does not account for patients’ personal conditions. A higher ratio of pretreatment C-reactive protein/albumin ratio (CAR) is associated with poor prognosis in nasopharyngeal carcinoma (NPC), and Epstein–Barr virus (EBV) DNA level is known to participate in the occurrence of nasopharyngeal carcinoma and affect the development and prognosis of the disease. We proposed that a combination of both these markers could improve the predictive prognostic ability
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