Cheng Guangyi, Yuan Shiwang, Wang Jiang, Deng Sijia, Wu Yang, Wang Yuyan, Shen Yu, Li Liantao
The First School of Clinical Medicine, Xuzhou Medical University, 9 Kunpeng Road, Xuzhou, Jiangsu, People's Republic of China.
Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Clin Transl Oncol. 2025 Jun;27(6):2638-2650. doi: 10.1007/s12094-024-03781-1. Epub 2024 Nov 12.
The purpose of the study was to explore the value of dynamic changes in inflammatory and nutritional index after comprehensive treatment in patients with stage III-IVA nasopharyngeal carcinoma (NPC). A prognostic model was also established and validated for progression-free survival (PFS) of patients.
We retrospectively selected 279 NPC patients with stage III-IVA. Their general clinical data and hematological index were collected and then calculated the changes during treatment. X-tile software was used to determine the optimal cut-off value. COX regression, Lasso method, and Boruta method were used to variable selection and model establishment. Using the bootstrap internal validation method, concordance index (C-index), calibration plot, and Kaplan-Meier curves were used to evaluate the model. To test the prognostic value of the model, we have also evaluated the performance of the nomogram against a conventional tumor metastasis staging system (TNM).
Multivariable COX regression analysis demonstrated that clinical staging, delta lymphocyte, delta monocyte, delta albumin, delta platelet-to-lymphocyte ratio and delta systemic immune inflammation index were related to the PFS of NPC patients. The C-index of the model was 0.712, and the calibration curve indicated that the model had good consistency. The C-index of the TNM staging system was 0.597, which was considerably lower compared to our model (P = 0.015).
We demonstrated the predictive value of dynamic changes in inflammatory and nutritional indices for the prognosis of NPC by successfully establishing and validating a prognostic model for predicting 1- and 3-year PFS after comprehensive treatment in patients with stage III-IVA NPC.
本研究旨在探讨Ⅲ-ⅣA期鼻咽癌（NPC）患者综合治疗后炎症和营养指标动态变化的价值。还建立并验证了患者无进展生存期（PFS）的预后模型。
我们回顾性选择了279例Ⅲ-ⅣA期NPC患者。收集他们的一般临床资料和血液学指标，然后计算治疗期间的变化。使用X-tile软件确定最佳截断值。采用COX回归、Lasso方法和Boruta方法进行变量选择和模型建立。使用自助法内部验证方法，采用一致性指数（C-index）、校准图和Kaplan-Meier曲线评估模型。为了检验该模型的预后价值，我们还针对传统肿瘤转移分期系统（TNM）评估了列线图的性能。
多变量COX回归分析表明，临床分期、淋巴细胞变化值、单核细胞变化值、白蛋白变化值、血小板与淋巴细胞比值变化值和全身免疫炎症指数变化值与NPC患者的PFS相关。该模型的C-index为0.712，校准曲线表明该模型具有良好的一致性。TNM分期系统的C-index为0.597，与我们的模型相比显著更低（P = 0.015）。
我们通过成功建立并验证一个预测Ⅲ-ⅣA期NPC患者综合治疗后1年和3年PFS的预后模型，证明了炎症和营养指标动态变化对NPC预后的预测价值。
