The value of detailed MR imaging report of primary tumor and lymph nodes on prognostic nomograms for nasopharyngeal carcinoma after intensity-modulated radiotherapy

Wan, Yanzi; Liu, Tian; Zhang, Guoyi; Xin, Hongyu; Li, Haojiang; Dong, Annan; Liang, Yiqin; Jing, Bingzhong; Zhou, Jian; Cui, Chunyan; Chen, Ming‐Yuan; Sun, Ying; Xie, Chuanbo; Liu, Lizhi; Shao, Yuanzhi

doi:10.1016/j.radonc.2018.11.001

Cited by 31 publications

(20 citation statements)

References 34 publications

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“…The inclusion criteria were as follows: (1) NPC with positive histological findings; (2) the first and only primary malignancy was NPC; (3) available follow-up data; and (4) International Classification of Disease-O-3 (ICD-O-3) site codes C11.0-C11.3, C11.8 and C11.9 and histologic codes 8010, 8020, 8021, 8070-8073, 8082, and 8083. The exclusion criteria were as follows: (1) survival data were missing or unknown; (2) reporting source was autopsy or death certificate only; and (3) metastatic status was missing or unknown.…”

Section: Patient Eligibility Criteriamentioning

confidence: 99%

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Pattern and prognosis of distant metastases in nasopharyngeal carcinoma: A large‐population retrospective analysis

Zhang

et al. 2020

Cancer Medicine

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Currently, the features and prognosis of nasopharyngeal carcinoma (NPC) with distant metastases are still rarely reported. Thus, the main purpose of our study was to investigate the metastasis patterns of different histological types of NPC and to clarify the prognostic characteristics of metastases at different sites. Patients were enrolled from the SEER program from 2010 to 2016. Chi‐squared tests were used to compare features between groups. The tendency to develop combined metastases was assessed with the odds ratio. The Kaplan‐Meier method was used for the survival analysis. Univariate and multivariate Cox analyses were used to select the independent prognostic risk factors for inclusion in the nomogram. In the present study, we found the following: (1) tumors are highly likely to metastasize if they have a larger volume, the regional lymph nodes are relatively large, or the regional lymph nodes are biopsied but not removed; (2) the bone and the brain were the most and least common metastatic sites among all histological types and N stages. Metastasis at two sites was the most common pattern, and bone metastasis was generally associated with metastasis to the liver or brain; (3) the prognostic analyses in metastatic patients showed that cancer‐specific survival (CSS) was relatively worse in patients with multiple metastases, and in those with liver metastasis regardless of the number of other metastatic sites; (4) A nomogram was constructed for clinical use based on four independent prognostic risk indicators, including histology, radiation therapy, chemotherapy, and metastatic status. Our findings provide a reference for clinical decision‐making and future diagnostic screening tests for NPC with distant metastases.

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Section: Patient Eligibility Criteriamentioning

confidence: 99%

“…decreased, and the 5-year survival has generally improved. 1,4,5 Currently, the main cause of death and the key obstacle to treatment are local recurrence and distant metastasis. [6][7][8] The incidence of bone metastasis is approximately 64%-67%, and bone is the most common site of metastases in NPC.…”

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confidence: 99%

Pattern and prognosis of distant metastases in nasopharyngeal carcinoma: A large‐population retrospective analysis

Zhang

et al. 2020

Cancer Medicine

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“…These variables were age group (<45 vs. ≥45 years), pre-DNA level (<4,000 vs. ≥4,000 copies/ml), T-stage (T1, T2, T3, and T4), chemotherapy (yes vs. no), laterality of RLN metastasis (no/unilateral vs. bilateral), upper cervical of LN metastasis (no/unilateral vs. bilateral), nodal metastasis of the neck region (no, upper region, and lower region), NG (yes vs. no), CNN (yes vs. no), ECS (yes vs. no), and the nodal numbers (in continuous). Age was categorized into <45-year-old group and ≥45-yearold group, as previous paper suggested that patients aged ≥45 years had poor survival (17). Then, we used stepwise method to select the above-screened variables that could be incorporated into the nomogram.…”

Section: Statistical Analysesmentioning

confidence: 99%

A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma

Xie¹,

Li²,

Yan³

et al. 2020

Front. Oncol.

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Distant metastasis is among the main reasons for treatment failure in nasopharyngeal carcinoma (NPC) patients. To identify patients with a high risk of distant metastasis is important to guide posttreatment surveillance, appropriate time treatments, and prolonging their long-term survival. In this study, we systematically examined the associations between a series of nodal-related characteristics and distant metastasis-free survival (DMFS) by detailed MRI reading and established a nomogram for DMFS in NPC patients. T-stage, age group, Epstein-Barr virus (EBV) level, central nodal necrosis, and nodal number were identified as independent risk factors for distant metastasis and were included into the final nomogram. The calibration plot showed a high agreement between the prediction by the nomogram and actual observations. Our established nomogram achieved a high C-index in predicting distant metastasis in both of the training cohort (0.737) and the validation cohort (0.718). This nomogram incorporated several readily available nodal features from the MR images, and it might be useful for guiding clinical decision and NPC patients' posttreatment surveillance. It also provides cues for how to redefine N-stage. Additional research is needed to confirm our conclusions.

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“…Therefore, it is necessary to build an effective prognostic model to identify patients with a poor prognosis for whom intensive follow-up and adjuvant chemotherapy may bring about more survival benefits. Thus, many efforts have been made to identify risk factors ranging from biomarkers, such as Epstein-Barr virus (EBV) DNA and gene expression, to radiomics (9)(10)(11)(12)(13). Multiplanar magnetic resonance imaging (MRI) is one of the methods most extensively used for the precise mapping of the tumor and the accurate evaluation of NPC.…”

Section: Introductionmentioning

confidence: 99%

“…Multiplanar magnetic resonance imaging (MRI) is one of the methods most extensively used for the precise mapping of the tumor and the accurate evaluation of NPC. In addition to precisely mapping the tumor and defining the T and N stages of NPC, attempts have been made to include information from MRI into the prognostic analysis of cancer (12,(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Prognostic and Treatment Guiding Significance of MRI-Based Tumor Burden Features and Nodal Necrosis in Nasopharyngeal Carcinoma

et al. 2020

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We aimed to develop a nomogram integrating MRI-based tumor burden features (MTBF), nodal necrosis, and some clinical factors to forecast the distant metastasis-free survival (DMFS) of patients suffering from non-metastatic nasopharyngeal carcinoma (NPC). A total of 1640 patients treated at Sun Yat-sen University Cancer Center (Guangzhou, China) from 2011 to 2016 were enrolled, among which 1148 and 492 patients were randomized to a training cohort and an internal validation cohort, respectively. Additionally, 200 and 257 patients were enrolled in the Foshan and Dongguan validation cohorts, respectively, which served as independent external validation cohorts. The MTBF were developed from the stepwise regression of six multidimensional tumor burden variables, based on which we developed a nomogram also integrating nodal necrosis and clinical features. This model divided the patients into high- and low-risk groups by an optimal cutoff. Compared with those of patients in the low-risk group, the DMFS [hazard ratio (HR): 4.76, 95% confidence interval (CI): 3.39–6.69; p < 0.0001], and progression-free survival (PFS; HR: 4.11, 95% CI: 3.13–5.39; p < 0.0001) of patients in the high-risk group were relatively poor. Furthermore, in the training cohort, the 3-year DMFS of high-risk patients who received induction chemotherapy (ICT) combined with concurrent chemoradiotherapy (CCRT) was better than that of those who were treated with CCRT alone ( p = 0.0340), whereas low-risk patients who received ICT + CCRT had a similar DMFS to those who only received CCRT. The outcomes we obtained were all verified in the three validation cohorts. The survival model can be used as a reliable prognostic tool for NPC patients and is helpful to determine patients who will benefit from ICT.

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The value of detailed MR imaging report of primary tumor and lymph nodes on prognostic nomograms for nasopharyngeal carcinoma after intensity-modulated radiotherapy

Cited by 31 publications

References 34 publications

Pattern and prognosis of distant metastases in nasopharyngeal carcinoma: A large‐population retrospective analysis

Pattern and prognosis of distant metastases in nasopharyngeal carcinoma: A large‐population retrospective analysis

A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma

Prognostic and Treatment Guiding Significance of MRI-Based Tumor Burden Features and Nodal Necrosis in Nasopharyngeal Carcinoma

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