A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma

Xie, Chuanbo; Li, Haojiang; Yan, Ye; Liang, Shuli; Li, Yanhong; Liu, Lizhi; Cui, Chunyan; Liu, Yuying

doi:10.3389/fonc.2020.00616

Cited by 15 publications

(29 citation statements)

References 27 publications

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“…Numerous studies have shown that T stage is closely associated with locoregional recurrence, whereas N stage is associated with distant metastasis in NPC. 4,[22][23][24] A higher N stage is a risk factor for distant metastasis in NPC, 23,25 which is consistent with the results of our study.…”

supporting

confidence: 90%

“…But MRI parameters are complex to acquire and are similarly not easy to apply clinically. 24 In our study, the nomogram constructed by combining CD4 + T lymphocytes, LDH, SF and N stage showed good predictive performance in both the training cohort (C-index = 0.763) and the validation cohort (C-index = 0.760). Moreover, circulating CD4 + T lymphocytes, serum LDH, and serum SF are readily detectable and inexpensive in the clinic with high reproducibility.…”

Section: Discussionsupporting

confidence: 55%

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A Nomogram Based on Circulating CD4+ T Lymphocytes and Lactate Dehydrogenase to Predict Distant Metastasis in Patients with Nasopharyngeal Carcinoma

Shen¹,

Chang²,

Chen³

et al. 2021

JIR

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Distant metastasis is the main pattern of treatment failure in nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). We aimed to establish and validate a prognostic nomogram to identify patients with a high risk of distant metastasis. Patients and Methods: A total of 503 patients with nonmetastatic NPC were included in this retrospective study. We established a prognostic nomogram for distant metastasis-free survival (DMFS) based on the Cox proportional hazards model. The predictive discriminative ability and accuracy of the nomogram were assessed with the concordance index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. The nomogram's clinical utility was also evaluated using decision curve analysis (DCA) and Kaplan-Meier method. The predictive ability of the nomogram was validated in an independent cohort. Results:The multivariate analysis showed that circulating CD4 + T lymphocytes, lactate dehydrogenase (LDH), serum ferritin (SF), and N stage were independent prognostic factors for DMFS. Then, we constructed the nomogram based on these factors. The C-indexes of the nomogram for distant metastasis were 0.763 (95% CI: 0.685-0.841) and 0.760 (95% CI: 0.643-0.877) in the training cohort and validation cohort, respectively, which was higher than the 8th TNM staging system (0.672 and 0.677). The calibration curve showed that the prediction results of the nomogram were in high agreement with the actual observation. The ROC curve indicated that the nomogram had a better predictive ability than TNM staging. The DCA also demonstrated that the nomogram was clinically beneficial. In addition, the patients were classified into two different risk groups (high-risk, low-risk) by the nomogram. Conclusion: As a supplement to TNM staging, our nomogram could provide a more effective and accurate prognostic prediction of distant metastasis in NPC patients. It has the potential to guide the individualized treatment of patients to improve their survival.

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supporting

confidence: 90%

Section: Discussionsupporting

confidence: 55%

A Nomogram Based on Circulating CD4+ T Lymphocytes and Lactate Dehydrogenase to Predict Distant Metastasis in Patients with Nasopharyngeal Carcinoma

Shen¹,

Chang²,

Chen³

et al. 2021

JIR

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“…Recently a nomogram was proposed by Xie et al, using MRI‐related nodal features, including nodal necrosis and the number of involved nodes, to predict distant metastasis. Nodal size, nodal level, and ECE were not found to have a statistically significant correlation to outcome in this study 94 …”

Section: Nodal Features That Influence Prognosiscontrasting

confidence: 72%

Contemporary management of the neck in nasopharyngeal carcinoma

Tsang

Beitler

et al. 2021

Head & Neck

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Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.

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“…Some studies suggested that these are not risk factors for distant metastasis. On the contrary, in the study by Xie et al [ 26 ], T stage, age-group, and EBV level were found to be independent risk factors for distant metastasis. In a propensity-matched analysis of 5929 Chinese patients with NPC, sex was found to significantly affect distant metastasis-free survival and females showed significant advantage over males in this respect [ 27 ].…”

Section: Discussionmentioning

confidence: 75%

Selectively recommend 18F-FDG PET/CT for patients with de novo nasopharyngeal carcinoma in endemic areas

Chen

Qiu

et al. 2021

Radiat Oncol

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Introduction To identify the subset of patients with de novo nasopharyngeal carcinoma (NPC) for whom [18F] fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) should be recommended, and to determine whether PET/CT is a cost-effective decision for precise M staging in endemic areas. Materials and methods Retrospective analysis of data of 4469 patients diagnosed with de novo NPC between January 2014 and December 2019. The detection rate of distant metastasis was compared between different groups. Univariate and multiple logistic regression analysis was applied to identify the risk factors for distant metastasis. The cost-effectiveness of the diagnostic strategies was assessed. Results The detection rate of distant metastasis in the whole cohort was 5.46%. In multivariate analysis, male sex, T3-4 stage, N2-3 stage, and high plasma Epstein-Barr virus (EBV) DNA (≥ 14,650 copies/mL) were risk factors for distant metastases. NPC patients with T3-4 stage combined with N2-3 stage, high EBV DNA combined with male sex, or N2-3 stage combined with high EBV DNA were defined as recommended group with relatively higher tendency for metastasis. Distant metastasis incidence in recommended group and unrecommended group were 10.25% and 1.75%, respectively (P < 0.001). In the recommended group, PET/CT significantly improved the detection rate of distant metastasis (13.25% vs 9.02%, P = 0.005). Cost-effectiveness analysis revealed that additional cost for every one percent increase in distant metastasis detection rate was $22,785.58 in the recommended group (< Willingness-to-pay (WTP) threshold of $32,700.00) and $310,912.90 in the unrecommended group. Conclusions In patients with de novo NPC, the tendency for metastasis can be predicted based on clinical parameters. 18F-FDG PET/CT should be selectively recommended for the subset of patients with a relatively higher tendency for metastasis.

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A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma

Cited by 15 publications

References 27 publications

A Nomogram Based on Circulating CD4+ T Lymphocytes and Lactate Dehydrogenase to Predict Distant Metastasis in Patients with Nasopharyngeal Carcinoma

A Nomogram Based on Circulating CD4+ T Lymphocytes and Lactate Dehydrogenase to Predict Distant Metastasis in Patients with Nasopharyngeal Carcinoma

Contemporary management of the neck in nasopharyngeal carcinoma

Selectively recommend 18F-FDG PET/CT for patients with de novo nasopharyngeal carcinoma in endemic areas

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