Prognostic Nomogram for Patients with Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy.
Prognostic Nomogram for Patients with Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy.
复制标题
DOI：
10.1371/journal.pone.0134491
复制
发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Xie C
中科院分区：
文献类型：
--
作者：
Wu S;Xia B;Han F;Xie R;Song T;Lu L;Yu W;Deng X;He Q;Zhao C;Xie C
本研究旨在确定鼻咽癌（NPC）总生存率的可能预测因素。患者接受调强放射治疗（IMRT），以建立一个有效的预后诺模图，可以提供个性化的预测在这种情况下的治疗结果。我们回顾了2002年至2009年在中山大学放射肿瘤学系接受调强放疗或同期化疗的533例非转移性鼻咽癌患者的记录;这些患者均未接受诱导或辅助化疗。这些数据集用于构建基于考克斯回归的列线图。通过一致性指数（C指数）和校准曲线确定诺模图性能，并与NPC的TNM分期系统进行比较。结果在温州医学院放射肿瘤科同期接受治疗的442例患者的外部队列中得到验证。结果显示，对生存率影响最大的是原发肿瘤体积、年龄、肿瘤分期和淋巴结分期（2002年国际癌症控制联盟[UICC]分期系统），这些因素被选入诺模图。预测生存期的C指数为0.748（95%CI，0.704-0.785），显著高于TNM分期的C指数（0.684，P<0.001）。校准曲线显示列线图预测的总生存期概率与实际观察到的总生存期概率一致。在验证队列中，列线图判别上级TNM分期系统（C指数：0.768 vs 0.721; P = 0.026）。总之，本研究中提出的诺模图对鼻咽癌患者调强放疗后的预后预测更准确，与TNM分期系统相比更有利;这种个性化信息将有助于患者咨询，并可用于未来的降级试验。
This study was aimed to define possible predictors of overall survival in nasopharyngeal carcinoma (NPC). Patients were treated with intensity-modulated radiation therapy (IMRT), to establish an effective prognostic nomogram that could provide individualized predictions of treatment outcome in this setting. We reviewed the records of 533 patients with non-metastatic NPC who underwent IMRT with or without concurrent chemotherapy at the Department of Radiation Oncology of Sun Yat-Sen University from 2002 to 2009; none of these patients received induction or adjuvant chemotherapy. These data sets were used to construct a nomogram based on Cox regression. Nomogram performance was determined via a concordance index (C-index) and a calibration curve which was compared with the TNM staging system for NPC. The results were validated in an external cohort of 442 patients from the Department of Radiation Oncology of Wenzhou Medical College who were treated during the same period. Results showed that the greatest influence on survival were primary gross tumor volume, age, tumor stage and nodal stage (2002 Union for International Cancer Control [UICC] staging system), which were selected into the nomogram. The C-index of the nomogram for predicting survival was 0.748 (95%CI, 0.704–0.785), which was statistically higher than that of TNM staging system (0.684, P<0.001). The calibration curve exhibited agreement between nomogram-predicted and the actual observed probabilities for overall survival. In the validation cohort, the nomogram discrimination was superior to the TNM staging system (C-index: 0.768 vs 0.721; P = 0.026). In conclusion, the nomogram proposed in this study resulted in more-accurate prognostic prediction for patients with NPC after IMRT and compared favorably to the TNM staging system; this individualized information will aid in patient counseling and may be used for de-escalation trials in the future.