Establishment and validation of a recursive partitioning analysis based prognostic model for guiding re-radiotherapy in locally recurrent nasopharyngeal carcinoma patients

Sun, Xiang; Zhu, Miao; Wen, Dong-Xiang; Luo, Dong-Hua; Sun, Rui; Chen, Qiuyan; Mai, Hai‐Qiang

doi:10.1016/j.radonc.2022.01.026

Cited by 4 publications

(4 citation statements)

References 40 publications

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“…In the present study, multivariate analysis showed that age ≥ 60 years, recurrence interval ≤ 2 years, plasma EBV DNA level > 0 copy/mL, and advanced recurrent T stage were independent predictors of mortality. This result is consistent with previous studies 14 , 29 - 31 . Sun et al found age, hypertension, relapsed T stage, and EBV DNA level to be independent prognostic factors 32 .…”

Section: Discussionsupporting

confidence: 94%

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Xiao,

Zou,

Chen

et al. 2024

J. Cancer

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Objective : To investigate the patterns of local failure and prognosis in patients with locally recurrent nasopharyngeal carcinoma (rNPC) after primary intensity-modulated radiotherapy (IMRT). Methods : The data of 298 patients with locally rNPC after IMRT were retrospectively analyzed. Magnetic resonance images of the initial and recurrent tumors were reviewed and, for patients with extra-nasopharyngeal local recurrence, the gross tumor volume of local recurrence was transferred to the original IMRT plan for dosimetry analysis. Significant prognostic factors for overall survival (OS) were selected by multivariate Cox regression analysis. Results : The commonest recurrence sites were the nasopharynx (93%, 277/298) and skull base (53.7%, 160/298). Of the 21 patients with extra-nasopharyngeal recurrence (19 cases valid), 12 had in-field failures, 4 had marginal failures, and 3 had out-field failures. The ethmoid sinus (57.1%, 4/7) and nasal cavity (28.6%, 2/7) were the most frequent sites of marginal and out-field failures. After median follow-up of 37 months, the 3-year and estimated 5-year OS rates were 57.3% and 41.7%, respectively. Multivariate analysis showed that age, recurrence interval, plasma Epstein-Barr virus (EBV) DNA level, and recurrent T stage were independent prognostic factors for OS. Conclusions : Local failure after IMRT occurs most commonly in the nasopharynx and skull base. In patients with extra-nasopharyngeal recurrence, in-field failure remains the main failure pattern, and marginal and out-field failures mainly occur in the ethmoid sinus and nasal cavity. Elder age, shorter recurrence interval, detectable plasma EBV DNA, and advanced recurrent T stage are negative predictors of OS in patients with rNPC.

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Section: Discussionsupporting

confidence: 94%

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Xiao,

Zou,

Chen

et al. 2024

J. Cancer

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“… 23 A total of 531 patients were included to conduct and validate a prognostic model based on a recursive partitioning analysis that divided patients into 3 groups. 36 Salvage RT could benefit rNPC patients in the low- and intermediate-risk groups, while not in the high-risk group. In this study, a predictive model for screening patients who could benefit from salvage RT was developed.…”

Section: Discussionmentioning

confidence: 99%

“…Several models have been constructed for the treatment stratification of patients. 22 , 35 – 37 A validated salvage radiotherapy outcome score was proposed that identified a low-score subgroup of the female sex, who had previous RT-induced grade 3 and higher-grade late toxicities, and suboptimal performance status. They had a significantly better survival benefit after receiving palliative CT alone than receiving salvage RT.…”

Section: Discussionmentioning

confidence: 99%

Impact of Radiotherapy Combined With Chemotherapy on Long-Term Outcomes of Patients With Recurrent Nasopharyngeal Carcinoma

Liu

et al. 2023

Technol Cancer Res Treat

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Background: It remains controversial whether the application of chemotherapy has an impact on recurrent nasopharyngeal carcinoma (rNPC) patients with salvage radiotherapy. Here, we aimed to evaluate treatment outcomes of rNPC patients and derive a prognostic model to assess the benefit of chemotherapy in patients with re-radiotherapy. Methods: This study was conducted as a retrospective study. In total, 340 rNPC patients treated with salvage intensity-modulated radiotherapy (IMRT) or radiochemotherapy (RCT) from October 2006 to September 2019 were included in this study. Overall survival (OS) was the primary outcome. Kaplan-Meier method was employed to detect the prognostic difference with Log-rank tests. The Cox regression analysis was performed to explore the potential prognostic factors while the multivariate Cox analysis was used to identify candidate variables for the prognostic model of OS. Results: The 5-year actuarial rates of OS, progression-free survival, loco-regional progression-free survival, and distant metastases-free survival did not show significant difference between the IMRT and RCT groups ( P > .05). Age at recurrence and rT category were found to be the independent prognostic factors for OS. We found that rNPC patients suffered poor OS in the high-risk group (patients with higher age at recurrence and advanced rT category) (high-risk vs low-risk, HR = 1.87, 95% CI: 1.36-2.57, P < .001). Salvage RT alone may be superior to RCT for patients in the low-risk group (RCT group vs RT group, HR = 1.89, 95% CI: 1.11-3.20, P = .038). Conclusion: Salvage RT combined with chemotherapy cannot improve survival outcomes for rNPC. More novel clinical trials should be explored to develop individualized strategies to improve survival and minimize toxicities.

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“…Variables that demonstrated observably significance in the multivariate analysis were included in a risk stratification model for OS using RPA. The RPA was used to select the best node in each split to get the best patient groups in each step, based on classification and regression tree (CART) analysis [ 23 ]. Each subgroup would be subsequently split into smaller groups until a specified stopping criterion is reached or further divisions could no longer be made.…”

Section: Methodsmentioning

confidence: 99%

Prognostic model on overall survival in elderly nasopharyngeal carcinoma patients: a recursive partitioning analysis identifying pre-treatment risk stratification

et al. 2023

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Background We aimed to evaluate the optimal management for elderly patients with nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT). Methods A total of 283 elderly patients with NPC diagnosed from 2015 to 2019 were enrolled in the study. Overall survival (OS) was the primary endpoint. Univariate and multivariate Cox regression analyses were preformed to identify potential prognostic factors. The recursive partitioning analysis (RPA) was used for risk stratification. Kaplan-Meier survival curves were applied to evaluate the survival endpoints, and log-rank test was utilized to assess differences between groups. The prognostic index (PI) was constructed to further predict patients’ prognosis displayed by nomogram model. The area under the receiver operating characteristic (ROC) curves (AUC) and the calibration curves were applied to assess the effectiveness of the model. Results Based on RPA-based risk stratification, we demonstrated that elderly NPC patients who were treated with IC followed by RT had similar OS as those with induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) in the middle- (stage I-III and pre-treatment EBV > 1840 copies/ml) and high-risk groups (stage IVA). IMRT alone may be the optimal treatment option for the low-risk group (stage I-III with pre-treatment EBV ≤ 1840 copies/ml). We established an integrated PI which was indicted with stronger prognostic power than each of the factors alone for elderly NPC patients (The AUC of PI was 0.75, 0.80, and 0.82 for 1-, 3-, 5-year prediction of OS, respectively). Conclusion We present a robust model for clinical stratification which could guide individual therapy for elderly NPC patients.

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Establishment and validation of a recursive partitioning analysis based prognostic model for guiding re-radiotherapy in locally recurrent nasopharyngeal carcinoma patients

Cited by 4 publications

References 40 publications

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Patterns and Prognosis of Local Recurrence of Nasopharyngeal Carcinoma after Intensity-modulated Radiotherapy

Impact of Radiotherapy Combined With Chemotherapy on Long-Term Outcomes of Patients With Recurrent Nasopharyngeal Carcinoma

Prognostic model on overall survival in elderly nasopharyngeal carcinoma patients: a recursive partitioning analysis identifying pre-treatment risk stratification

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