: Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine (LQT, CFL, JL, WHC, QYC, LZ, SSG, LTL, LG, YSW, DHL, PYH, HYM, YQX, RS, MYC, YJH, XL, LW, CZ, KJC, CNQ, XG, YXZ, HQM, MSZ), Department of Nasopharyngeal Carcinoma (LQT, QYC, LZ, SSG, LTL, LG, YSW, DHL, PYH, HYM, YQX, RS, MYC, YJH, XL, LW, CZ, KJC, CNQ, XG, HQM), Department of Information Technology (CFL), Department of Medical Statistics and Epidemiology, the School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China (LXY); ZhongShan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China (XPL, YH, YXXX, DPH, SHW, YTP).
J Natl Cancer Inst. 2015 Oct 14;108(1). doi: 10.1093/jnci/djv291. Print 2016 Jan.
This study aimed to establish an effective prognostic nomogram with or without plasma Epstein-Barr virus DNA (EBV DNA) for nondisseminated nasopharyngeal carcinoma (NPC).
The nomogram was based on a retrospective study of 4630 patients who underwent radiotherapy with or without chemotherapy at Sun Yat-sen University Cancer Center from 2007 to 2009. The predictive accuracy and discriminative ability of the nomogram were determined by a concordance index (C-index) and calibration curve and were compared with EBV DNA and the current staging system. The results were validated using bootstrap resampling and a prospective cohort study on 1819 patients consecutively enrolled from 2011 to 2012 at the same institution. All statistical tests were two-sided.
Independent factors derived from multivariable analysis of the primary cohort to predict recurrence were age, sex, body mass index (BMI), T stage, N stage, plasma EBV DNA, pretreatment high sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), and hemoglobin level (HGB), which were all assembled into the nomogram with (nomogram B) or without EBV DNA (nomogram A). The calibration curve for the probability of recurrence showed that the nomogram-based predictions were in good agreement with actual observations. The C-index of nomogram B for predicting recurrence was 0.728 (P < .001), which was statistically higher than the C-index values for nomogram A (0.690), EBV DNA (0.680), and the current staging system (0.609). The C-index of nomogram B (0.730) and nomogram A (0.681) remained higher for predicting recurrence among patients treated with intensity-modulated radiotherapy (P < .001). The results were confirmed in the validation cohort.
The proposed nomogram with or without plasma EBV DNA resulted in more accurate prognostic prediction for NPC patients.
本研究旨在建立一个包含或不包含血浆 Epstein-Barr 病毒 DNA（EBV DNA）的有效预后列线图，用于非播散性鼻咽癌（NPC）。
该列线图基于中山大学肿瘤防治中心 2007 年至 2009 年接受放疗联合或不联合化疗的 4630 例患者的回顾性研究。通过一致性指数（C 指数）和校准曲线来确定列线图的预测准确性和判别能力，并与 EBV DNA 和当前分期系统进行比较。通过bootstrap 重采样和同一机构 2011 年至 2012 年连续入组的 1819 例前瞻性队列研究对结果进行验证。所有统计检验均为双侧。
多变量分析确定的独立因素，用于预测复发的因素有年龄、性别、体质指数（BMI）、T 分期、N 分期、血浆 EBV DNA、治疗前高敏 C 反应蛋白（hs-CRP）、乳酸脱氢酶（LDH）和血红蛋白水平（HGB），这些因素均被纳入列线图（列线图 B）或不包含 EBV DNA（列线图 A）。复发概率的校准曲线表明，基于列线图的预测与实际观察结果吻合良好。预测复发的列线图 B 的 C 指数为 0.728（P<0.001），显著高于列线图 A（0.690）、EBV DNA（0.680）和当前分期系统（0.609）的 C 指数。在接受调强放疗的患者中，列线图 B（0.730）和列线图 A（0.681）的 C 指数仍然更高，用于预测复发（P<0.001）。该结果在验证队列中得到了证实。
提出的包含或不包含血浆 EBV DNA 的列线图，可更准确地预测 NPC 患者的预后。
