Oncology Department of Northern Jiangsu People's Hospital, Affiliated Hospital to Yangzhou University, Yangzhou, China,
Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
ORL J Otorhinolaryngol Relat Spec. 2023;85(4):195-207. doi: 10.1159/000530053. Epub 2023 May 5.
The aim of the study was to retrospectively identify the metastatic influence factors and predict the prognosis and develop an individualized prognostic prediction model for patients with N3-stage nasopharyngeal carcinoma (NPC).
The study collected 446 NPC patients with N3 stage from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The patients were classified into subgroups based on the histological types and metastatic status. Multivariable logistic, Cox regression, and Kaplan-Meier method with the log-rank test were performed. The nomogram model was created using the prognostic factors identified from Cox regression analysis. The predictive accuracy was determined based on the concordance index (c-index) and calibration curves.
The 5-year overall survival (OS) of the NPC patients with N3 stage was 43.9%, and the prognosis of patients without any distant metastases was largely longer than that with metastases. No difference was observed between different pathological types in the entire cohort. However, patients with non-keratinized squamous cell carcinoma had a better OS than that of the patients with keratinized squamous cell carcinoma in a nonmetastatic subgroup. Using the Cox regression analysis results, the nomogram successfully classified these patients into low- and high-risk subgroups and presented the survival difference. The c-index of the nomogram for predicting the prognosis was satisfactory.
This study identified metastatic risk factors and developed a convenient clinical tool for the prognosis of NPC patients. This tool can be used for individualized risk classification and decision-making regarding treatment of NPC patients with N3 stage.
本研究旨在回顾性分析影响转移性鼻咽癌（NPC）N3 期患者的预后因素，并预测其预后，建立个体化的预后预测模型。
本研究收集了 2010 年至 2015 年期间监测、流行病学和最终结果数据库中 446 例 NPC N3 期患者。根据组织学类型和转移状态将患者分为亚组。采用多变量逻辑、Cox 回归和 Kaplan-Meier 方法与对数秩检验进行分析。采用 Cox 回归分析确定的预后因素构建列线图模型。根据一致性指数（c-index）和校准曲线确定预测准确性。
NPC N3 期患者的 5 年总生存率（OS）为 43.9%，无远处转移患者的预后明显长于有远处转移患者。在整个队列中，不同病理类型之间的预后无差异。然而，在无转移亚组中，非角化性鳞状细胞癌患者的 OS 优于角化性鳞状细胞癌患者。利用 Cox 回归分析结果，该列线图成功地将这些患者分为低危和高危亚组，并显示了生存差异。该列线图预测预后的 c-index 令人满意。
本研究确定了转移性风险因素，并为 NPC N3 期患者的预后建立了一种方便的临床工具。该工具可用于 NPC N3 期患者的个体化风险分类和治疗决策。
