A Nomogram Based on Serum Biomarkers and Clinical Characteristics to Predict Survival in Patients With Non-Metastatic Nasopharyngeal Carcinoma

Abstract

ObjectiveThis study focused on developing an effective nomogram for improving prognostication for patients with primary nasopharyngeal carcinoma (NPC) restaged according to the eighth edition of the AJCC/UICC TNM staging system.MethodsBased on data of 5,903 patients with non-metastatic NPC (primary cohort), we used Cox regression analysis to identify survival risk factors and created a nomogram. We used the nomogram to predict overall survival (OS), distant metastasis-free survival (DMFS) and disease-free survival (DFS) in the primary and independent validation (3,437 patients) cohorts. Moreover, we compared the prognostic accuracy between the 8th TNM system and the nomogram.ResultsThe nomogram included gender, age, T stage, N stage, Epstein–Barr virus DNA, hemoglobin, C-reactive protein, lactate dehydrogenase, and radiotherapy with/without induction or concurrent chemotherapy. In the prediction of OS, DMFS and DFS, the nomogram had significantly higher concordance index (C-index) and area under ROC curve (AUC) than the TNM system alone. Calibration curves demonstrated satisfactory agreements between nomogram-predicted and observed survival. The stratification in different groups permitted remarkable differentiation among Kaplan–Meier curves for OS, DMFS, and DFS.ConclusionThe nomogram led to a more precise prognostic prediction for NPC patients in comparison with the 8th TNM system. Therefore, it could facilitate individualized and personalized patients’ counseling and care.

Establishment of a Prognostic Nomogram for Patients With Locoregionally Advanced Nasopharyngeal Carcinoma Incorporating TNM Stage, Post-Induction Chemotherapy Tumor Volume and Epstein-Barr Virus DNA Load

“…Clinicopathological variables associated with progression risk were assessed according to basic theoretical knowledge, clinical significance, and predictors confirmed by previous studies (11,(18)(19)(20). Continuous variables were converted into categorical variables, which are presented as a whole number and proportion.…”

“…Previous studies have reported that pretreatment EBV DNA load is considered to be an indicator of tumor load, and is correlated with risk stratification and prognosis prediction ( 22 – 25 ). In addition, Li’s ( 19 ) and Yang’s ( 18 ) studies both developed a nomogram for survival prediction using pretreatment EBV-DNA load. However, the clinical prognostic models containing EBV DNA load after IC is limited.…”

“…The optimal thresholds for pre-DNA, GTVnx, and GTVnd were calculated by receiver operating characteristic (ROC) curve analysis. Other variables were grouped according to the findings reported in previous studies (age, pre-LDH, pre-HGB, and pre-ALB) ( 11 , 19 , 20 ).…”

LncRNA FOXD3-AS1 Promotes the Malignant Progression of Nasopharyngeal Carcinoma Through Enhancing the Transcription of YBX1 by H3K27Ac Modification

“…The 5-year overall survival rate (OS) of locally advanced nasopharyngeal carcinoma is 68% ~ 80% and the main reason of treatment failure is distant metastasis ( 6 ). However, outcomes vary greatly even patients are at the same stage, because the current staging system does not take into account patients’ basic physical conditions, such as age and tumor size, which have been proved to be independent prognostic factors in other studies ( 7 , 8 ). It seems a good idea to explain the differences of outcomes of patients at the molecular level.…”

Development and validation of a risk prediction score for patients with nasopharyngeal carcinoma

“…Recently, there have been several attempts to improve NPC prognostication through the use of blood molecular biomarkers, including circulating Epstein-Barr virus (EBV) DNA, serum lactate dehydrogenase (LDH) [ 7 ], globulin (GLOB), hs-CRP [ 8 ], and neutrophil/lymphocyte ratio (NLR) [ 9 ]. The infection of EBV is virtually 100% associated with NPC in endemic areas.…”