Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China.
Department of Medical Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, China.
Radiother Oncol. 2022 Jun;171:107-113. doi: 10.1016/j.radonc.2022.04.017. Epub 2022 Apr 21.
It remains uncertain whether induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) or CCRT plus adjuvant chemotherapy (AC) is more effective in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). This study aimed to develop and validate a joint radiomic and clinical signature (RCS) for the prognostic stratification of LA-NPCs and to identify patients who might benefit more from IC + CCRT or CCRT + AC.
Overall, 893 LA-NPC patients who received IC + CCRT or CCRT + AC were enrolled from four hospitals. RCS based on pretreatment magnetic resonance images and clinical data was constructed for predicting 5-year progression-free survival (PFS). The predictive ability of the RCS and TNM staging system for 5-year PFS, locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were compared by Harrell's concordance indices (C-indices). Patients were divided into high- and low-risk subgroups based on RCS scores. The survival benefit of IC + CCRT vs. CCRT + AC in different subgroups was compared by Kaplan-Meier survival curves.
The RCS combining the radiomic signature, TNM stage and EBV DNA demonstrated significantly higher C-indices than TNM stage for predicting 5-year PFS, LRRFS, DMFS and OS in the training and validation cohorts. In the high-risk group (RCS score ≥ 0.25), CCRT + AC achieved significantly better PFS, LRRFS, DMFS and OS than IC + CCRT. In the low-risk group (RCS score < 0.25), IC + CCRT yielded significantly better outcomes than CCRT + AC.
The RCS provides a noninvasive way to predict the outcomes of LA-NPC and helps identify patients who may benefit more from IC + CCRT vs. CCRT + AC.
局部晚期鼻咽癌（LA-NPC）患者采用诱导化疗（IC）联合同期放化疗（CCRT）或 CCRT 联合辅助化疗（AC），哪种方案更有效目前仍不确定。本研究旨在建立和验证一种联合放射组学和临床特征（RCS）的评分系统，以对 LA-NPC 患者进行预后分层，并识别可能从 IC+CCRT 或 CCRT+AC 中获益更多的患者。
本研究共纳入来自 4 家医院的 893 例接受 IC+CCRT 或 CCRT+AC 治疗的 LA-NPC 患者。基于治疗前磁共振图像和临床数据构建 RCS，以预测 5 年无进展生存率（PFS）。采用 Harrell 一致性指数（C 指数）比较 RCS 和 TNM 分期系统对 5 年 PFS、局部区域无复发生存率（LRRFS）、无远处转移生存率（DMFS）和总生存率（OS）的预测能力。根据 RCS 评分将患者分为高风险和低风险亚组。采用 Kaplan-Meier 生存曲线比较不同亚组中 IC+CCRT 与 CCRT+AC 的生存获益。
在训练和验证队列中，联合放射组学特征、TNM 分期和 EBV DNA 的 RCS 对预测 5 年 PFS、LRRFS、DMFS 和 OS 的 C 指数均显著高于 TNM 分期。在高危组（RCS 评分≥0.25）中，CCRT+AC 的 PFS、LRRFS、DMFS 和 OS 明显优于 IC+CCRT。在低危组（RCS 评分<0.25）中，IC+CCRT 的生存获益明显优于 CCRT+AC。
RCS 提供了一种预测 LA-NPC 患者预后的无创方法，并有助于识别可能从 IC+CCRT 中获益更多的患者。
