Huang Run-Da, Sun Zhuang, Wang Xiao-Hui, Tian Yun-Ming, Peng Ying-Lin, Wang Jing-Yun, Xiao Wei-Wei, Chen Chun-Yan, Deng Xiao-Wu, Han Fei
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Guangzhou, China.
Front Oncol. 2021 Jan 20;10:625184. doi: 10.3389/fonc.2020.625184. eCollection 2020.
To assess the impact of comorbidity on treatment outcomes in patients with locally recurrent nasopharyngeal carcinoma (lrNPC) using intensity-modulated radiotherapy (IMRT) and to develop a nomogram that combines prognostic factors to predict clinical outcome and guide individual treatment.
This was a retrospective analysis of patients with lrNPC who were reirradiated with IMRT between 2003 and 2014. Comorbidity was evaluated by Adult Comorbidity Evaluation-27 grading (ACE-27). The significant prognostic factors (P < 0.05) by multivariate analysis using the Cox regression model were adopted into the nomogram model. Harrell concordance index (C-index) calibration curves were applied to assess this model.
Between 2003 and 2014, 469 lrNPC patients treated in our institution were enrolled. Significant comorbidity (moderate or severe grade) was present in 17.1% of patients by ACE-27. Patients with no or mild comorbidity had a 5-year overall survival (OS) rate of 36.2 20.0% among those with comorbidity of moderate or severe grade (P < 0.0001). The chemotherapy used was not significantly different in patients with lrNPC (P > 0.05). For the rT3-4 patients, the 5-year OS rate in the chemotherapy + radiation therapy (RT) group was 30.0 16.7% for RT only (P = 0.005). The rT3-4 patients with no or mild comorbidity were associated with a higher 5-year OS rate in the chemotherapy + RT group than in the RT only group (32.1 and 17.1%, respectively; P=0.003). However, for the rT3-4 patients with a comorbidity (moderate or severe grade), the 5-year OS rate in the chemotherapy + RT group RT alone was not significantly different (15.7 15.0%, respectively; p > 0.05). Eight independent prognostic factors identified from multivariable analysis were fitted into a nomogram, including comorbidity. The C-index of the nomogram was 0.715. The area under curves (AUCs) for the prediction of 1-, 3-, and 5-year overall survival were 0.770, 0.764, and 0.780, respectively.
Comorbidity is among eight important prognostic factors for patients undergoing reirradiation. We developed a nomogram for lrNPC patients to predict the probability of death after reirradiation and guide individualized management.
评估合并症对局部复发性鼻咽癌（lrNPC）患者采用调强放射治疗（IMRT）的治疗结果的影响，并制定一种结合预后因素的列线图，以预测临床结果并指导个体化治疗。
这是一项对2003年至2014年间接受IMRT再程放疗的lrNPC患者的回顾性分析。采用成人合并症评估-27分级（ACE-27）评估合并症。使用Cox回归模型进行多变量分析得出的显著预后因素（P < 0.05）被纳入列线图模型。应用Harrell一致性指数（C指数）校准曲线评估该模型。
2003年至2014年间，本机构收治的469例lrNPC患者被纳入研究。根据ACE-27评估，17.1%的患者存在显著合并症（中度或重度）。无合并症或轻度合并症患者的5年总生存率为36.2%，中度或重度合并症患者为20.0%（P < 0.0001）。lrNPC患者使用的化疗无显著差异（P > 0.05）。对于rT3-4患者，化疗 + 放射治疗（RT）组的5年总生存率为30.0%，单纯RT组为16.7%（P = 0.005）。无合并症或轻度合并症的rT3-4患者在化疗 + RT组中的5年总生存率高于单纯RT组（分别为32.1%和17.1%；P = 0.003）。然而，对于合并症（中度或重度）的rT3-4患者，化疗 + RT组与单纯RT组的5年总生存率无显著差异（分别为15.7%和15.0%；P > 0.05）。从多变量分析中确定的8个独立预后因素被纳入列线图，包括合并症。列线图的C指数为0.715。预测1年、3年和5年总生存率的曲线下面积（AUC）分别为0.770、0.764和0.780。
合并症是接受再程放疗患者的8个重要预后因素之一。我们为lrNPC患者开发了一种列线图，以预测再程放疗后的死亡概率并指导个体化管理。
