Establishment of a prognostic nomogram to identify optimal candidates for local treatment among patients with local recurrent nasopharyngeal carcinoma
Establishment of a prognostic nomogram to identify optimal candidates for local treatment among patients with local recurrent nasopharyngeal carcinoma
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建立预后列线图以确定局部复发鼻咽癌患者局部治疗的最佳候选者
DOI：
10.1016/j.oraloncology.2020.104711
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发表时间：
2020-07-01
期刊：
影响因子：
4.8
通讯作者：
Mai, Hai-Qiang
中科院分区：
文献类型：
--
作者：
Sun, Xue-Song;Liang, Yu-Jing;Mai, Hai-Qiang
目的：鼻咽癌局部复发的治疗方法至今尚无定论。在此，我们开发了一个诺模图，结合预后生物标志物来预测临床结果和指导个体化treatment.Materials和方法：从2006年至2016年，303例lrNPC患者进行了回顾性分析。总生存期（OS）是主要终点。采用考克斯回归模型进行多因素分析，筛选出有统计学意义（P < 0.05）的预后因素，建立列线图。Harrell一致性指数（C-index）、校正曲线和决策曲线分析（DCA）对模型进行评价。结果：从多变量分析中确定的4个独立预后因素（年龄、高血压、复发T（rT）分期和EB病毒DNA）被纳入诺模图。列线图的C指数为0.687。1年、3年和5年OS率的校准曲线显示预测值与实际值之间的一致性令人满意。决策曲线分析也显示了该模型较好的净效益。根据列线图将所有患者细分为三个风险组。在低危组（P < 0.001）和中危组（P = 0.001）中，局部治疗的OS高于单纯姑息化疗。结论：我们建立的nomogram图可用于预测lrNPC患者的OS并指导个体化治疗，其准确性、区分能力和临床实用性均令人满意。
Objective: Thus far, there is no final conclusion on the treatment of local recurrent nasopharyngeal carcinoma (lrNPC) patients. Herein, we developed a nomogram which combined prognostic biomarkers to predict clinical outcome and guide individual treatment.Materials and methods: From 2006 to 2016, 303 patients with lrNPC were retrospectively reviewed. Overall survival (OS) was the primary endpoint. The nomogram was established with the significant prognostic factors (P < 0.05) selected by multivariate analysis using Cox regression model. Harrell Concordance Index (C-index), calibration curves, and decision curve analysis (DCA) were applied to evaluate this model.Results: Four independent prognostic factors (age, hypertension, relapsed T (rT) stage, and Epstein-Barr virus DNA) identified from multivariable analysis were included into the nomogram. The C-index of the nomogram was 0.687. The calibration curves for 1-, 3-, and 5-year OS rate showed satisfactory agreements between the predicted and actual values. The decision curve analysis also exhibited a preferable net benefit of this model. All patients were subdivided into three risk groups based on the nomogram. Local treatment was associated with higher OS than palliative chemotherapy alone in the low (P < 0.001) and intermediate-risk groups (P = 0.001). However, no significant difference was observed between different treatment methods in the high-risk group (P = 0.176).Conclusion: We established the nomogram for patients with lrNPC to predict OS and guide individual treatment, which showed satisfactory performance in accuracy, discrimination capability, and clinical utility.