Yuan Jing, Ni Wei-Qiong, Lin Yong-Miao, Chen Ao-Qiang, Long Zhi-Qing, Wang Si-Fen, Duan Fang-Fang, Zhang Chao, Huang Xin, Zhang Xue-Wen, Liu Xin-Yu, Xia Wen, Xie De-Huan, Zhang Yu-Ling, Du Sha-Sha, Hua Xin
State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Department of Radiation Oncology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China.
Eur J Med Res. 2025 Jul 21;30(1):644. doi: 10.1186/s40001-025-02793-z.
Nasopharyngeal carcinoma (NPC) is a prevalent malignancy characterized by variable outcomes, even after standardized treatment protocols. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system has proven limited in its ability to predict survival, which highlights the necessity for the discovery of new biomarkers.
This study was a retrospective analysis of 842 NPC patients who received platinum-based concurrent chemoradiotherapy (CCRT). The cholesterol-to-lymphocyte ratio (CLR) was calculated and evaluated as a potential prognostic factor. Both univariate and multivariate analyses were conducted to pinpoint independent prognostic variables. Furthermore, CLR-based nomograms were developed and assessed for its predictive accuracy.
Low CLR (≤ 3.06) was significantly linked to both improved overall survival (OS; HR = 0.640, 95% CI 0.473-0.866, P < 0.001)and progression-free survival (PFS; HR = 0.754, 95% CI 0.586-0.970, P = 0.028). Multivariate analysis confirmed CLR as an independent prognostic factor for OS (but only in univariate analysis for PFS). Additionally, age, tumor stage, nodal stage, and body mass index were independently associated with both OS and PFS in multivariate analysis. The CLR-based nomogram showed superior discriminative performance compared to the traditional staging system, with higher C-indices for both OS(0.668 vs 0.635) and PFS (0.655 vs 0.625).
CLR stands as an independent prognostic factor for NPC patients undergoing CCRT. The CLR-based nomogram (incorporating five independent prognostic factors: age, T stage, N stage, BMI, and CLR) provides a tailored approach to predicting survival, enabling healthcare providers to adjust treatment strategies in accordance with individual risk profiles. Further validation of these findings in external cohorts is necessary, as well as exploration of CLR's clinical utility in directing treatment decisions.
鼻咽癌（NPC）是一种常见的恶性肿瘤，即使采用标准化治疗方案，其预后也存在差异。美国癌症联合委员会（AJCC）/国际癌症控制联盟（UICC）分期系统在预测生存方面的能力有限，这凸显了发现新生物标志物的必要性。
本研究对842例接受铂类同步放化疗（CCRT）的鼻咽癌患者进行了回顾性分析。计算胆固醇与淋巴细胞比值（CLR）并将其作为潜在的预后因素进行评估。进行单因素和多因素分析以确定独立的预后变量。此外，还开发了基于CLR的列线图并评估其预测准确性。
低CLR（≤3.06）与总生存期（OS）改善（HR = 0.640，95%CI 0.473 - 0.866，P < 0.001）和无进展生存期（PFS）改善（HR = 0.754，95%CI 0.586 - 0.970，P = 0.028）均显著相关。多因素分析证实CLR是OS的独立预后因素（但仅在PFS的单因素分析中）。此外，在多因素分析中，年龄、肿瘤分期、淋巴结分期和体重指数均与OS和PFS独立相关。与传统分期系统相比，基于CLR的列线图显示出更好的判别性能，OS的C指数更高（0.668对0.635），PFS的C指数更高（0.655对0.625）。
CLR是接受CCRT的鼻咽癌患者的独立预后因素。基于CLR的列线图（纳入五个独立预后因素：年龄、T分期、N分期、BMI和CLR）提供了一种个性化的生存预测方法，使医疗保健提供者能够根据个体风险概况调整治疗策略。需要在外部队列中进一步验证这些发现，并探索CLR在指导治疗决策中的临床应用。
