Tan Xi-Rong, Huang Sheng-Yan, Gong Sha, Chen Yang, Yang Xiao-Jing, He Qing-Mei, He Shi-Wei, Liu Na, Li Ying-Qing
State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China.
Onco Targets Ther. 2021 Jan 6;14:29-37. doi: 10.2147/OTT.S286009. eCollection 2021.
Serum cystatin C has been considered as a significant prognostic factor for various malignancies. This study aimed to evaluate the relationship between serum cystatin C level before antitumor treatment and the prognosis of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).
A cohort of 2077 NPC patients were enrolled between April 2009 and September 2012. The Kaplan-Meier curves and log rank tests were used to determine the differences of overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox regression analyses were used to determine independent prognostic factors.
Overall, 362/2077 (17.4%) patients had high serum cystatin C level, and they were older and more male (both <0.001), and they had higher TNM stage (all <0.05). Kaplan-Meier analysis revealed that patients with high serum cystatin C had worse OS (<0.001) and DFS (<0.001). Univariate and multivariate Cox regression analysis showed that high serum cystatin C level was an independent prognostic predictor of OS (HR: 1.56, 95%CI: 1.25-1.95) and DFS (HR: 1.38, 95%CI: 1.13-1.68). Subgroup analysis based on TNM stage revealed that advanced-stage NPC patients with high serum cystatin C had poorer OS (<0.001) and DFS (<0.001).
Our results revealed that high serum cystatin C level before antitumor treatment can predict clinical outcomes of NPC patients treated with IMRT, and it can guide clinicians to formulate more personalized therapy for NPC patients.
血清胱抑素C已被视为多种恶性肿瘤的重要预后因素。本研究旨在评估抗肿瘤治疗前血清胱抑素C水平与接受调强放疗（IMRT）的鼻咽癌（NPC）患者预后之间的关系。
2009年4月至2012年9月期间纳入了2077例NPC患者队列。采用Kaplan-Meier曲线和对数秩检验来确定总生存期（OS）和无病生存期（DFS）的差异。使用单因素和多因素Cox回归分析来确定独立预后因素。
总体而言，362/2077（17.4%）例患者血清胱抑素C水平较高，他们年龄更大且男性更多（均<0.001），并且TNM分期更高（均<0.05）。Kaplan-Meier分析显示，血清胱抑素C水平高的患者OS（<0.001）和DFS（<0.001）更差。单因素和多因素Cox回归分析表明，血清胱抑素C水平高是OS（HR：1.56，95%CI：1.25 - 1.95）和DFS（HR：1.38，95%CI：1.13 - 1.68）的独立预后预测因素。基于TNM分期的亚组分析显示，血清胱抑素C水平高的晚期NPC患者OS（<0.001）和DFS（<0.001）更差。
我们的结果表明，抗肿瘤治疗前血清胱抑素C水平高可预测接受IMRT治疗的NPC患者的临床结局，并可指导临床医生为NPC患者制定更个性化的治疗方案。
