Weng Youliang, Wu Lishui, Li Ying, Wang Jing, Wu Zijie, Hong Xinyi, Liu Xiaoyong, Lai Jinghua, Lu Jun, Qiu Sufang
Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, (Fujian Branch of the Affiliated Cancer Hospital of Fudan University), Fujian, China.
Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, (Fujian Branch of the Affiliated Cancer Hospital of Fudan University), No. 420, Fuma Road, Jin'an District, Fuzhou 350014 Fujian, China.
Ther Adv Med Oncol. 2024 Oct 14;16:17588359241286489. doi: 10.1177/17588359241286489. eCollection 2024.
Plasma Epstein-Barr virus (EBV) DNA has been identified as a significant prognostic marker for nasopharyngeal carcinoma (NPC), yet there is limited research on the prognosis of NPC patients with negative EBV DNA.
We explore the prognostic value of comprehensive immune-inflammatory and nutritional indicators to offer personalized treatment recommendations and prognosis predictions for non-metastatic NPC patients with negative EBV DNA.
This was a retrospective study.
This study retrospectively analyzed 257 non-metastatic NPC patients with negative EBV DNA between January 2015 and December 2019. The Kaplan-Meier survival curves evaluated survival endpoints, and group discrepancies were assessed with log-rank tests. Principal component analysis (PCA) reduced data dimensionality. Univariate and multivariate Cox regression analyses identified significant prognostic variables. Risk stratification was performed based on recursive partitioning analysis (RPA). A robust prognostic model was constructed by nomogram and evaluated by calibration curves, decision curves, and the time-dependent area under the curve analysis.
PCA was employed to compute the immune-inflammation index (III) and nutrition index (NI). Multivariate Cox regression analysis revealed lactate dehydrogenase, III, and NI as significant prognostic variables for overall survival (OS). Utilizing RPA, we stratified the risk into three categories: low-risk group (low III + high NI), middle-risk group (low III + low NI), and high-risk group (high III). Both the middle- ( = 0.025) and high-risk groups ( < 0.001) exhibited poorer OS compared with the low-risk group. The nomogram model exhibited superior predictive accuracy compared to tumor lymph node metastasis stage alone (C-index: 0.774 vs 0.679).
Our study validated the prognostic significance of III and NI in non-metastatic NPC patients with negative EBV DNA. Additionally, a clinical risk stratification was constructed to offer valuable insights into the individualized treatment of these patients.
血浆 Epstein-Barr 病毒（EBV）DNA 已被确定为鼻咽癌（NPC）的重要预后标志物，但关于 EBV DNA 阴性的 NPC 患者预后的研究有限。
我们探讨综合免疫炎症和营养指标的预后价值，为 EBV DNA 阴性的非转移性 NPC 患者提供个性化治疗建议和预后预测。
这是一项回顾性研究。
本研究回顾性分析了 2015 年 1 月至 2019 年 12 月期间 257 例 EBV DNA 阴性的非转移性 NPC 患者。采用 Kaplan-Meier 生存曲线评估生存终点，并通过对数秩检验评估组间差异。主成分分析（PCA）降低数据维度。单因素和多因素 Cox 回归分析确定显著的预后变量。基于递归划分分析（RPA）进行风险分层。通过列线图构建稳健的预后模型，并通过校准曲线、决策曲线和曲线下时间依赖性面积分析进行评估。
采用 PCA 计算免疫炎症指数（III）和营养指数（NI）。多因素 Cox 回归分析显示乳酸脱氢酶、III 和 NI 是总生存期（OS）的显著预后变量。利用 RPA，我们将风险分为三类：低风险组（低 III + 高 NI）、中风险组（低 III + 低 NI）和高风险组（高 III）。与低风险组相比，中风险组（P = 0.025）和高风险组（P < 0.001）的 OS 均较差。列线图模型与单独的肿瘤淋巴结转移分期相比，显示出更高的预测准确性（C 指数：0.774 对 0.679）。
我们的研究验证了 III 和 NI 在 EBV DNA 阴性的非转移性 NPC 患者中的预后意义。此外，构建了临床风险分层，为这些患者的个体化治疗提供了有价值的见解。
