Lin Yinbing, Chen Jiechen, Wang Xiao, Chen Sijie, Yang Yizhou, Hong Yingji, Lin Zhixiong, Yang Zhining
Department of Radiation Oncology, Shantou University Medical College Cancer Hospital, Shantou University, Shantou, China.
Shantou University Medical College, Shantou University, Shantou, China.
Front Oncol. 2023 Mar 16;13:1083713. doi: 10.3389/fonc.2023.1083713. eCollection 2023.
Locoregionally advanced nasopharyngeal carcinoma (LA-NPC) patients, even at the same stage, have different prognoses. We aim to construct a prognostic nomogram for predicting the overall survival (OS) to identify the high-risk LA-NPC patients.
Histologically diagnosed WHO type II and type III LA-NPC patients in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled as the training cohort (n= 421), and LA-NPC patients from Shantou University Medical College Cancer Hospital (SUMCCH) served as the external validation cohort (n= 763). Variables were determined in the training cohort through Cox regression to form a prognostic OS nomogram, which was verified in the validation cohort, and compared with traditional clinical staging using the concordance index (C-index), Kaplan-Meier curves, calibration curves and decision curve analysis (DCA). Patients with scores higher than the specific cut-off value determined by the nomogram were defined as high-risk patients. Subgroup analyses and high-risk group determinants were explored.
Our nomogram had a higher C-index than the traditional clinical staging method (0.67 vs. 0.60, p<0.001). Good agreement between the nomogram-predicted and actual survival were shown in the calibration curves and DCA, indicating a clinical benefit of the nomogram. High-risk patients identified by our nomogram had worse prognosis than the other groups, with a 5-year overall survival (OS) of 60.4%. Elderly patients at advanced stage and without chemotherapy had a tendency for high risk than the other patients.
Our OS predictive nomogram for LA-NPC patients is reliable to identify high-risk patients.
局部区域晚期鼻咽癌（LA-NPC）患者即使处于同一分期，预后也有所不同。我们旨在构建一个预测总生存期（OS）的预后列线图，以识别高危LA-NPC患者。
将监测、流行病学和最终结果（SEER）数据库中组织学诊断为WHO II型和III型的LA-NPC患者纳入训练队列（n = 421），来自汕头大学医学院附属肿瘤医院（SUMCCH）的LA-NPC患者作为外部验证队列（n = 763）。通过Cox回归在训练队列中确定变量，以形成预后OS列线图，并在验证队列中进行验证，然后使用一致性指数（C指数）、Kaplan-Meier曲线、校准曲线和决策曲线分析（DCA）与传统临床分期进行比较。得分高于列线图确定的特定临界值的患者被定义为高危患者。进行亚组分析并探索高危组的决定因素。
我们的列线图的C指数高于传统临床分期方法（0.67对0.60，p<0.001）。校准曲线和DCA显示列线图预测的生存与实际生存之间具有良好的一致性，表明列线图具有临床益处。我们的列线图确定的高危患者的预后比其他组更差，5年总生存期（OS）为60.4%。晚期且未接受化疗的老年患者比其他患者有更高的高危倾向。
我们用于LA-NPC患者的OS预测列线图在识别高危患者方面是可靠的。
