Risk factors and prediction-score model for distant metastasis in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

Abstract

The objective of this study is to identify the risk factors and construct a prediction-score model for distant metastasis (DM) in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT). A total of 520 nonmetastatic NPC patients were analysed retrospectively. The independent risk factors for DM were tested by multivariate Cox regression analysis. The prediction-score model was established according to the regression coefficient. The median follow-up was 88.4 months. The 5-year DM rate was 15.1%. N2-3, primary tumour volume of nasopharynx (GTVnx) >24.56 cm(3), haemoglobin change after treatment (ΔHGB) >25.8 g/L, albumin-globulin ratio (AGR) ≤1.34, pretreatment neutrophil-lymphocyte ratio (NLR) >2.81 and pretreatment serum lactate dehydrogenase (LDH) >245 U/L were significantly adverse independent predictive factors for DM. Three subgroups were defined based on the prediction-score model: low risk (0-2), intermediate risk (3-4) and high risk (5-8). The 5-year DM rates were 4.6, 21.8 and 50.8%, respectively (P < 0.001). The areas under the curve for DM in the prediction-score model and the UICC/AJCC staging system seventh edition were 0.748 and 0.627, respectively (P < 0.001). The scoring model is useful in evaluating the risk of DM in IMRT-treated NPC patients and guiding future therapeutic trials. Further prospective study is needed.

JMJD2A promotes the Warburg effect and nasopharyngeal carcinoma progression by transactivating LDHA expression

“…Abnormal LDHA expression is universal in many human cancers, such as pancreatic cancer [31], hepatocellular carcinoma [32], and breast cancer [33], suggesting that the overexpression of this gene promotes cancer development and progression. LDHA is reported to be an adverse independent prognostic factor for NPC [34]. In our present study, the LDHA level was elevated, and correlated with the TNM and clinical stage in NPC tissue samples.…”

Radiomics Features of Multiparametric MRI as Novel Prognostic Factors in Advanced Nasopharyngeal Carcinoma

“…We showed that radiomics features complemented the TNM staging system, helping to provide better prognostic ability for pretreatment PFS. This complementary ability illustrates the clinical importance of our findings as TNM staging is routinely used in clinical practice (35,36). Currently, the TNM staging system is used for risk stratification and treatment decision making.…”

Identifying pretreatment baseline factors predictive of distant metastasis in patients with nasopharyngeal carcinoma after radiotherapy

“…[29] Another study demonstrated that NLR > 2.81 was a significant adverse independent predictive factor for DM. [30] However, in our study, the pretreatment LMR value and pretreatment NLR were not statistically significant by multivariate analysis, although its P -value was <.05 by univariate analysis. The relationship between these 2 factors and metastasis of NPC remains to be further explored.…”

“…[27,28] We also found a few studies have examined the relationship between NLR and DM in cancer patients. [22,29,30] One found that NLR > 5 predicts shorter overall survival in patients with head and neck squamous cell carcinoma. [29] Another study demonstrated that NLR > 2.81 was a significant adverse independent predictive factor for DM.…”