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

Abstract

ObjectivesTo establish and validate an effective nomogram to predict clinical outcomes for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).Materials and MethodsThe clinicopathological parameters and follow-up information of 402 locoregionally advanced NPC patients (training cohort, n = 302; validation cohort, n = 100) were retrospectively enrolled. The nomogram was built with the important prognostic variables identified by Cox regression analysis. Overall survival (OS) and progression-free survival (PFS) were the primary and secondary endpoints, respectively. The predictive power and clinical utility of the nomogram were assessed using the Harrell concordance index (C-index), calibration curve, and decision curve analysis. We compared the eighth staging system model with the nomogram to analyze whether the model could improve the accuracy of prognosisResultsEpstein–Barr virus (EBV) DNA load, the gross tumor volume (GTVnx), and cervical lymph node tumor volume (GTVnd) after induction chemotherapy were the independent predictors of OS and PFS. The calibration curves indicated superb agreement between the nomogram-predicted probabilities and observed actual probabilities of survival. The C-index and area under the receiver operator characteristic curve (AUC) of the nomogram integrating these significant factors and N stage, and TNM stage were higher than those of the eighth TNM system alone. In addition, the decision curve analyses demonstrated the clinical value and higher overall net benefit of the nomogram. High-risk groups identified by the nomogram had significantly poorer OS and PFS than the low-risk group (p < 0.05).ConclusionsThe multidimensional nomogram incorporating TNM stage, EBV DNA load, and tumor volume after induction chemotherapy led to a more precise prognostic prediction and could be helpful for stratifying risk and guiding treatment decisions in locoregionally advanced NPC patients who have undergone induction chemotherapy and concurrent chemoradiation.

Prognostic significance of wait time for radical radiotherapy in locoregionally advanced nasopharyngeal carcinoma

“…Intensity‐modulated radiation therapy (IMRT) was administered to all patients. Detailed treatment information were previously reported 13 and presented in Supporting Information.…”

Optimize the number of cycles of induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma: a propensity score matching analysis

“…In this study, IC regime failed to be an independent prognostic factor for survival outcomes. Additionally, all regimens included in this study (TPF, TP, PF, GP) were platinum-based and recommended according to the guideline, which have been widely used in many hospitals 16 , 18 , 21 . Second, the data from a single institution do not provide robust evidence.…”

“…The detailed measurement of EBV DNA level was reported by our previous study 18 , The cutoff value for pretreatment EBV DNA level (pre-EBV DNA) was set at 5000 copies/mL, which was calculated by receiver operator characteristic (ROC) curve analysis.…”

“…All patients underwent radical IMRT. Detailed chemotherapy and radiotherapy treatment information is in accordance with the principles of our previous studies and shown in Supplementary Materials 18 , 19 .…”

Efficiency of high cumulative cisplatin dose in high‐ and low‐risk patients with locoregionally advanced nasopharyngeal carcinoma

“…Detailed information on chemotherapy, radiotherapy, measurements of EBV DNA level and tumor volumes was reported in our previous study 19 and is also shown in the Supporting Information materials.…”