一种基于炎症、营养和凝血特征的新型预后模型可预测非转移性鼻咽癌的预后。
A Novel Prognostic Model Predicts Outcomes in Non-Metastatic Nasopharyngeal Carcinoma Based on Inflammation, Nutrition, and Coagulation Signature.
作者信息
Chen Li-Zhi, Li Han-Shu, Han Gao-Wei, Su Yong, Lu Tian-Zhu, Xie Hong-Hui, Gong Xiao-Chang, Li Jin-Gao, Xiao Yun
机构信息
NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Jiangxi Clinical Research Center for Cancer, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330029, People's Republic of China, Nanchang, Jiangxi, 330029, People's Republic of China.
Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China.
出版信息
J Inflamm Res. 2023 Nov 22;16:5515-5529. doi: 10.2147/JIR.S423928. eCollection 2023.
PURPOSE
This study aimed to assess the prognostic and predictive value of a circulating hematological signature (CHS) and to develop a CHS-based nomogram for predicting prognosis and guiding individualized chemotherapy in non-metastatic nasopharyngeal carcinoma (NPC) patients.
PATIENTS AND METHODS
NPC patients were recruited between January 2014 and December 2017 at the Jiangxi Cancer Hospital. The CHS was constructed based on a series of hematological indicators. The nomogram was developed by CHS and clinical factors.
RESULTS
A total of 779 patients were included. Three biomarkers were selected by least absolute shrinkage and selection operator regression, including prognostic nutritional index, albumin-to-fibrinogen ratio, and prealbumin-to-fibrinogen ratio, were used to construct the CHS. The patients in the low-CHS group had better 5-year DMFS and OS than those in the high-CHS group in the training (DMFS: 85.0% vs 56.6%, <0.001; OS: 90.3% vs 65.4%, <0.001) and validation cohorts (DMFS: 92.3% vs 43.6%, <0.001; OS: 92.1% vs 65.5%, <0.001). The nomogram_CHS showed better performance than clinical stage in predicting distant metastasis (concordance index: 0.728 vs 0.646). In the low-TRS (total risk scores) group, the patients received RT alone, CCRT and IC plus CCRT had similar 5-year DMFS and OS (>0.05). In the middle-TRS group, the patients received RT alone had worse 5-year DMFS (58.7% vs 80.8% vs 90.8%, =0.002) and OS (75.0% vs 94.1% vs 95.0%, =0.001) than those received CCRT or IC plus CCRT. In the high-TRS group, the patients received RT alone and CCRT had worse 5-year DMFS (18.6% vs 31.3% vs 81.5%, <0.001) and OS (26.9% vs 53.2% vs 88.8%, <0.001) than those received IC plus CCRT.
CONCLUSION
The developed nomogram_CHS had satisfactory prognostic accuracy in NPC patients and may individualize risk estimation to facilitate the identification of suitable IC candidates.
目的
本研究旨在评估循环血液学特征（CHS）的预后和预测价值，并开发一种基于CHS的列线图，用于预测非转移性鼻咽癌（NPC）患者的预后并指导个体化化疗。
患者与方法
2014年1月至2017年12月期间，在江西省肿瘤医院招募NPC患者。CHS基于一系列血液学指标构建。列线图由CHS和临床因素开发而成。
结果
共纳入779例患者。通过最小绝对收缩和选择算子回归选择了三个生物标志物，包括预后营养指数、白蛋白与纤维蛋白原比值以及前白蛋白与纤维蛋白原比值，用于构建CHS。在训练队列（无远处转移生存期[DMFS]：85.0%对56.6%，<0.001；总生存期[OS]：90.3%对65.4%，<0.001）和验证队列（DMFS：92.3%对43.6%，<0.001；OS：92.1%对65.5%，<0.001）中，低CHS组患者的5年DMFS和OS均优于高CHS组。列线图_CHS在预测远处转移方面表现优于临床分期（一致性指数：0.728对0.646）。在低总风险评分（TRS）组中，单纯接受放疗、同步放化疗（CCRT）以及诱导化疗（IC）加CCRT的患者5年DMFS和OS相似（>0.05）。在中TRS组中，单纯接受放疗的患者5年DMFS（58.7%对80.8%对90.8%，=0.002）和OS（75.0%对94.1%对95.0%，=0.001）均比接受CCRT或IC加CCRT的患者差。在高TRS组中，单纯接受放疗和CCRT的患者5年DMFS（18.6%对31.3%对81.5%，<0.001）和OS（26.9%对53.2%对88.8%，<0.001）均比接受IC加CCRT的患者差。
结论
所开发的列线图_CHS在NPC患者中具有令人满意的预后准确性，可能实现风险评估个体化，以促进识别合适的IC候选者。
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