Revalidation of a prognostic score model based on complete blood count for nasopharyngeal carcinoma through a prospective study

Abstract

ObjectiveIn our previous work, we incorporated complete blood count (CBC) into TNM stage to develop a new prognostic score model, which was validated to improve prediction efficiency of TNM stage for nasopharyngeal carcinoma (NPC). The purpose of this study was to revalidate the accuracy of the model, and its superiority to TNM stage, through data from a prospective study.MethodsCBC of 249 eligible patients from the 863 Program No. 2006AA02Z4B4 was evaluated. Prognostic index (PI) of each patient was calculated according to the score model. Then they were divided by the PI into three categories: the low-, intermediate-and high-risk patients. The 5-year disease-specific survival (DSS) of the three categories was compared by a log-rank test. The model and TNM stage (7th edition) were compared on efficiency for predicting the 5-year DSS, through comparison of the area under curve (AUC) of their receiver-operating characteristic curves.ResultsThe 5-year DSS of the low-, intermediate-and high-risk patients were 96.0%, 79.1% and 62.2%, respectively. The low-and intermediate-risk patients had better DSS than the high-risk patients (P<0.001 and P<0.005, respectively). And there was a trend of better DSS in the low-risk patients, compared with the intermediate-risk patients (P=0.049). The AUC of the model was larger than that of TNM stage (0.726 vs. 0.661, P=0.023). ConclusionsA CBC-based prognostic score model was revalidated to be accurate and superior to TNM stage on predicting 5-year DSS of NPC.

Cycle number of neoadjuvant chemotherapy might influence survival of patients with T1-4N2-3M0 nasopharyngeal carcinoma

“…Nasopharyngeal carcinoma (NPC) originates from the epithelial cells covering the surface of nasopharynx (1), and it is a rare malignancy with an age-standardized incidence of <1/100,000 person-years, except in certain endemic regions such as South China (2,3). Due to anatomical complexity of NPC and its tendency to metastasize, radiotherapy instead of surgery is the main therapeutic modality (4,5). Since the advent of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy (CCT), the highest 5-year overall survival (OS) of NPC in the literature has now achieved 85.0% (6).…”

Prognostic Factors for Overall Survival in Nasopharyngeal Cancer and Implication for TNM Staging by UICC: A Systematic Review of the Literature

“…Among the 64 studies on non-TNM factors, 18 proposed parameters were identified. Prognostic factors with consistent support from multiple studies included EBV-DNA level ( Table 3 ), primary gross tumor volume (GTV) ( 63 , 72 – 74 , 76 , 78 – 81 ), nodal GTV ( Table 4 ) ( 74 , 75 , 77 , 81 ), neutrophil-lymphocyte ratio (NLR) ( Table 5 ) ( 83 , 85 , 91 , 92 , 97 ), C-reactive protein (CRP)/albumin ratio ( 83 , 89 , 98 ), anemia ( 84 , 87 , 96 ), platelet count ( 82 , 86 ), lactate dehydrogenase (LDH) ( 88 , 95 ), and SUV max of the primary tumor ( 99 – 101 , 103 , 108 , 111 , 113 ) and total lesion glycolysis (TLG) ( Table 6 ) ( 104 , 111 ).…”

“…In the 18 studies that were included, nine inflammatory/hematological markers were evaluated: the most frequently proposed marker (n = 5) is NLR ( 83 , 85 , 91 , 92 , 97 ), followed by anemia (n = 3) ( 84 , 87 , 96 ), LDH (n = 2) ( 88 , 95 ), platelet count (n = 2) ( 82 , 86 ), and the CRP/albumin ratio (n = 3) ( 83 , 89 , 98 ). Other proposals with limited supporting evidence included high-sensitivity CRP (hs-CRP; n = 1) ( 54 ), platelet distribution width (PDW) ( 86 ), prognostic nutrition index (PNI) and albumin/globulin ratio (AGR) (n = 1) ( 93 ), D-dimer (n = 1) ( 94 ), and tumor-infiltrating lymphocytes (TIL; n = 1) ( 90 ).…”

Radiotherapy Effect on Complete Blood Count Parameter in Patients With Nasopharyngeal Carcinoma

“…In general, inflammatory cells could enhance the proliferating and metastatic abilities of tumor cells. Therefore, the elevated level of inflammatory cells might affect prognosis adversely [6,10].…”

“…It is chosen because it is fast, inexpensive, and has a practical functional index. Moreover, the CBC could reflect the biological characteristics of tumor cells indirectly and combining it with the TNM stage is very useful for building a more accurate predicting system of NPC patients' individualized outcomes [6]. However, there has been no study regarding the effect of radiotherapy on the CBC parameter.…”