Jiang Yu-Ting, Chen Kai-Hua, Yang Jie, Liang Zhong-Guo, Qu Song, Li Ling, Zhu Xiao-Dong
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
Department of Oncology, Affiliated Wuming Hospital of Guangxi Medical University, Nanning, China.
Front Oncol. 2021 Jun 16;11:683475. doi: 10.3389/fonc.2021.683475. eCollection 2021.
To establish and validate an effective nomogram to predict clinical outcomes for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).
The 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 prognosis.
Epstein-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).
The 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.
建立并验证一种有效的列线图，以预测局部区域晚期鼻咽癌（LA-NPC）患者的临床结局。
回顾性纳入402例局部区域晚期鼻咽癌患者的临床病理参数和随访信息（训练队列，n = 302；验证队列，n = 100）。通过Cox回归分析确定重要的预后变量，构建列线图。总生存期（OS）和无进展生存期（PFS）分别为主要和次要终点。使用Harrell一致性指数（C指数）、校准曲线和决策曲线分析评估列线图的预测能力和临床实用性。我们将第八版分期系统模型与列线图进行比较，以分析该模型是否能提高预后准确性。
诱导化疗后的爱泼斯坦-巴尔病毒（EBV）DNA载量、肿瘤总体积（GTVnx）和颈部淋巴结肿瘤体积（GTVnd）是OS和PFS的独立预测因素。校准曲线表明列线图预测的生存概率与观察到的实际生存概率之间具有极佳的一致性。整合这些重要因素以及N分期和TNM分期的列线图的C指数和受试者操作特征曲线下面积（AUC）高于单独的第八版TNM系统。此外，决策曲线分析证明了列线图的临床价值和更高的总体净效益。列线图确定的高危组的OS和PFS明显低于低危组（p < 0.05）。
纳入TNM分期、EBV DNA载量和诱导化疗后肿瘤体积的多维列线图可实现更精确的预后预测，有助于对接受诱导化疗和同步放化疗的局部区域晚期鼻咽癌患者进行风险分层和指导治疗决策。
