Abstract
ObjectivesTo establish and validate an effective nomogram to predict clinical outcomes for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).Materials and MethodsThe clinicopathological parameters and follow-up information of 402 locoregionally advanced NPC patients (training cohort, n = 302; validation cohort, n = 100) were retrospectively enrolled. The nomogram was built with the important prognostic variables identified by Cox regression analysis. Overall survival (OS) and progression-free survival (PFS) were the primary and secondary endpoints, respectively. The predictive power and clinical utility of the nomogram were assessed using the Harrell concordance index (C-index), calibration curve, and decision curve analysis. We compared the eighth staging system model with the nomogram to analyze whether the model could improve the accuracy of prognosisResultsEpstein–Barr virus (EBV) DNA load, the gross tumor volume (GTVnx), and cervical lymph node tumor volume (GTVnd) after induction chemotherapy were the independent predictors of OS and PFS. The calibration curves indicated superb agreement between the nomogram-predicted probabilities and observed actual probabilities of survival. The C-index and area under the receiver operator characteristic curve (AUC) of the nomogram integrating these significant factors and N stage, and TNM stage were higher than those of the eighth TNM system alone. In addition, the decision curve analyses demonstrated the clinical value and higher overall net benefit of the nomogram. High-risk groups identified by the nomogram had significantly poorer OS and PFS than the low-risk group (p < 0.05).ConclusionsThe multidimensional nomogram incorporating TNM stage, EBV DNA load, and tumor volume after induction chemotherapy led to a more precise prognostic prediction and could be helpful for stratifying risk and guiding treatment decisions in locoregionally advanced NPC patients who have undergone induction chemotherapy and concurrent chemoradiation.
Highlights
Nasopharyngeal carcinoma (NPC) is a malignant tumor with a high incidence in South China
The other inclusion criteria included: [1] receiving induction chemotherapy (IC) with Concurrent chemoradiation (CCRT); [2] no history of radiotherapy, and/or chemotherapy before our study; and [3] clinical data, examination information, and follow-up data were available; and [4] no serious diseases or other sources of tumors when diagnosed with NPC
The results showed that tumor volume and Epstein-Barr virus (EBV) DNA load after induction chemotherapy (IC) are independent predictors for survival
Summary
Nasopharyngeal carcinoma (NPC) is a malignant tumor with a high incidence in South China. A previous randomized phase 2 study reported that the application of IC to CCRT was superior to CCRT alone for 3-year overall survival (OS, 94.1% vs 67.7%, P = 0.012), and led to a trend to improve progression-free survival [4]. Later a phase 3 randomized controlled trial provided evidence that cisplatin/fluorouracil/docetaxel (TPF) induction chemotherapy (IC) followed by CCRT provided 5-year overall survival (OS: 85.6% vs 77.7%, p = 0.042) benefits compared with CCRT alone in LA-NPC [5], and improved long-term failure-free survival (FFS, 77.4% vs 66.4%, p = 0.019), distant failure-free survival (DMFS, 88% vs 79.8%, p = 0.030), and locoregional failure-free survival (FFS, 90.7% vs 83.8%, p = 0.044). Developing a prognostic model for predicting survival outcome and early progression to guide risk stratification and treatment regimen modification is urgent
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