Development of a Prognostic Model to Identify the Suitable Definitive Radiation Therapy Candidates in de Novo Metastatic Nasopharyngeal Carcinoma: A Real-World Study

Li, Wang‐Zhong; Lv, Shu‐Hui; Li, Guoying; Hu, Liang; Guo, Xiang; Lv, Xing; Liu, Kui-Yuan; Qiang, Meng‐Yun; Chen, Xi; Gu, Sophie Z.; Xie, Changqing; Xia, Wei‐Xiong; Xiang, Yan‐Qun

doi:10.1016/j.ijrobp.2020.08.045

Cited by 32 publications

(46 citation statements)

References 44 publications

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“…[29][30][31] In addition to systemic therapy, locoregional radiotherapy combined with chemotherapy was associated with significantly prolonged OS in chemotherapy-sensitive de novo mNPC patients. 21,22 Therefore, we believe that the pretherapy prediction of first-line chemotherapy efficacy is crucial for the timely identification of patients who might have an inadequate response to chemotherapy, allowing personalized treatment recommendations to be designed from the start.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment information for the study population has previously been described in detail elsewhere. 21 This study's primary outcome was progression-free survival (PFS), which was defined as the time interval between first-line chemotherapy initiation and tumor progression submit your manuscript | www.dovepress.com…”

Section: Treatments and Outcomesmentioning

confidence: 99%

“…20 Our previous work and an updated clinical trial have confirmed that additional locoregional radiotherapy can significantly improve survival among those who show satisfactory first-line chemotherapy responses. 21,22 However, roughly 35% of all de novo mNPC patients do not exhibit satisfactory responses to first-line chemotherapy. These patients represent an under-appreciated subgroup that might require more intense therapy.…”

Section: Introductionmentioning

confidence: 99%

“…ALP has been identified to serve as a reliable indicator for the prediction of prognosis associated with several malignancies, including NPC. 21,32,41 Currently, the exact mechanisms and functions through which ALP is associated with tumor progression remain undefined; however, elevated tumor-derived ALP has been demonstrated to regulate cancer cell proliferation, death, and epithelial plasticity. 42,43 These findings suggested that ALP could be a potential therapeutic target, and recent studies have shown that bonetargeted ALP can act as a form of enzyme replacement therapy for hypophosphatasia, highlighting the promising role of ALP as a therapeutic target.…”

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confidence: 99%

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A Scoring System Based on Nutritional and Inflammatory Parameters to Predict the Efficacy of First-Line Chemotherapy and Survival Outcomes for De Novo Metastatic Nasopharyngeal Carcinoma

Li¹,

Hua²,

Lv³

et al. 2021

JIR

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Purpose We aimed to develop a simple scoring system based on baseline inflammatory and nutritional parameters to predict the efficacy of first-line chemotherapy and survival outcomes for de novo metastatic nasopharyngeal carcinoma (mNPC). Patients and Methods We retrospectively collected ten candidate inflammatory and nutritional parameters from de novo mNPC patients who received platinum-based first-line chemotherapy treatment. We examined the effects of these ten candidate variables on progression-free survival (PFS) using the Cox regression model. We built a risk-scoring system based on the regression coefficients associated with the identified independent prognostic factors. The predictive accuracy of the scoring system was evaluated and independently validated. Results A total of 460 patients were analyzed. Four independent prognostic factors were identified in a training cohort and were used to construct the scoring system, including nutritional risk index, C-reactive protein level, alkaline phosphatase level, and lactate dehydrogenase level. Based on the score obtained from the scoring system, we stratified patients into three prognostic subgroups (low: 0–1 point, intermediate: 2–3 points, and high: 4 points) associated with significantly different disease control rates (94.7% vs. 92.5% vs. 66.0%, respectively) and survival outcomes (3-year PFS: 55.8% vs. 29.1% vs. 11.9%, respectively). The scoring system had a good performance for the prediction of short-term disease control (area under the receiver operating characteristic curve [AUC]: 0.701) and long-term survival outcomes (time-dependent AUC for 5-year PFS: 0.713). The results were internally validated using an independent cohort (AUC for predicting disease control: 0.697; time-dependent AUC for 5-year PFS: 0.713). Conclusion We developed and validated a clinically useful risk-scoring system that could predict the efficacy of first-line chemotherapy and survival outcomes in de novo mNPC patients. This system may help clinicians to design personalized treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Treatments and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Scoring System Based on Nutritional and Inflammatory Parameters to Predict the Efficacy of First-Line Chemotherapy and Survival Outcomes for De Novo Metastatic Nasopharyngeal Carcinoma

Li¹,

Hua²,

Lv³

et al. 2021

JIR

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“…In the article that accompanies this editorial, Li et al from Sun Yat-Sen University Cancer Center offer a prognostic model for identifying the patients most likely to benefit from the addition of LRRT consolidation after PCT. 6 In this retrospective report, 460 patients from 2008 to 2015 were treated with either PCT and LRRT (n Z 244) or PCT alone (n Z 216). Eligible patients received at least 2 cycles of PCT, although more than half (293/460; 64%) had received at least 6 (PCT-LRRT 60.2% vs PCT alone 67.6%).…”

mentioning

confidence: 99%

Locoregional Radiation Therapy for De Novo Metastatic Nasopharyngeal Cancer: One Size Fits All?

McDowell

Rischin

Lee

2021

International Journal of Radiation Oncology*Biology*Physics

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Assessment of Survival Model Performance Following Inclusion of Epstein-Barr Virus DNA Status in Conventional TNM Staging Groups in Epstein-Barr Virus–Related Nasopharyngeal Carcinoma

et al. 2021

JAMA Netw Open

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IMPORTANCE Nonanatomic prognostic factors complement the traditional anatomic staging system and could be incorporated into the tumor-node-metastasis (TNM) framework. Several diseases have incorporated nonanatomic prognostic factors into the determination of TNM staging groups. OBJECTIVE To refine TNM staging groups for Epstein-Barr virus (EBV)-related nonmetastatic nasopharyngeal carcinoma (NPC) by incorporating EBV DNA status. DESIGN, SETTING, AND PARTICIPANTS This multicenter prognostic study included patients with NPC treated with radiotherapy at 2 hospitals in China from January 2008 to December 2016. Progression-free survival and overall survival according to EBV DNA status and the TNM staging system were compared. Recursive partitioning analysis (RPA) combined with supervised clustering was applied to derive prognostic groupings, and then a refined RPA staging schema was developed, validated, and compared with existing staging schemes. Statistical analyses were conducted from October 1, 2020, to June 15, 2021. EXPOSURES Curative intensity-modulated radiotherapy with or without platinum-based chemotherapy. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival. The performance of the staging system was assessed using the time-dependent area under the receiver operating characteristic curves and the TNM stage system's evaluation methodology. RESULTS A total of 2354 patients (1709 men [72.6%]; median [interquartile range] age, 45 [38-53] years) were split into training (1372 [58.3%]), internal validation (672 [28.5%]), and external validation (310 [13.2%]) cohorts. Pretreatment EBV DNA was detected in 1338 (56.8%) patients. EBV DNA status was an independent prognostic factor: lower survival probability by higher TNM stage was evident in EBV DNA-positive patients but not in those with EBV DNA-negative disease. After integrating EBV DNA status and TNM stage, nonmetastatic NPC cases were categorized into RPA-I (T1-3N0 or EBV DNA-negative T1-3N1 cancers), RPA-II (EBV DNA-positive T1-3N1-2 or EBV DNA-negative T1-3N2-3/T4N0-3 cancers), and RPA-III (EBV DNA-positive T4N0-3/T1-3N3 cancers) groups, each with distinctly different prognosis. This system of RPA staging outperformed the current TNM stage system and 2 reported RPA staging schemes. These results were internally and externally validated.

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Development of a Prognostic Model to Identify the Suitable Definitive Radiation Therapy Candidates in de Novo Metastatic Nasopharyngeal Carcinoma: A Real-World Study

Cited by 32 publications

References 44 publications

A Scoring System Based on Nutritional and Inflammatory Parameters to Predict the Efficacy of First-Line Chemotherapy and Survival Outcomes for De Novo Metastatic Nasopharyngeal Carcinoma

A Scoring System Based on Nutritional and Inflammatory Parameters to Predict the Efficacy of First-Line Chemotherapy and Survival Outcomes for De Novo Metastatic Nasopharyngeal Carcinoma

Locoregional Radiation Therapy for De Novo Metastatic Nasopharyngeal Cancer: One Size Fits All?

Assessment of Survival Model Performance Following Inclusion of Epstein-Barr Virus DNA Status in Conventional TNM Staging Groups in Epstein-Barr Virus–Related Nasopharyngeal Carcinoma

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