Modeling Sarcopenia to Predict Survival for Patients With Nasopharyngeal Carcinoma Receiving Concurrent Chemoradiotherapy.
Modeling Sarcopenia to Predict Survival for Patients With Nasopharyngeal Carcinoma Receiving Concurrent Chemoradiotherapy.
复制标题
建立肌肉减少症模型来预测接受同步放化疗的鼻咽癌患者的生存期。
DOI：
10.3389/fonc.2021.625534
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发表时间：
2021
影响因子：
4.7
通讯作者：
Guo L
中科院分区：
文献类型：
--
作者：
Hua X;Li WZ;Huang X;Wen W;Huang HY;Long ZQ;Lin HX;Yuan ZY;Guo L
本研究的目的是建立一个预后诺模图，包括EB病毒DNA（EBV-DNA）和肌肉减少症的鼻咽癌（NPC）患者接受同步放化疗（CCRT）。在这项回顾性分析中，我们研究了2010年至2014年期间接受CCRT治疗的1，045例NPC患者。使用常规放疗前第三颈椎计算机断层扫描确定肌肉减少症。使用受试者工作特征（ROC）曲线分析确定肌肉减少症和血浆EBV-DNA的截止值来构建新的S-E等级。根据S-E分级和传统的预后因素建立列线图。校正曲线、时间依赖ROC、决策曲线分析和一致性指数（C-index）确定了诺模图的预测和区分准确性，并与TNM分期系统和传统诺模图进行了比较。当使用肌肉减少症（P < 0.001）或EBV-DNA（P = 0.001）时，患者存活率显著不同，并且在单变量（分别为P < 0.001，P = 0.002）和多变量（分别为P < 0.001，P = 0.015）分析中，它们仍然是存活率的独立预后因素。使用S-E分级预测总生存期（OS）比单独使用TNM分期和肌肉减少症或EBV-DNA更准确。然后基于所识别的独立预后因素开发列线图B（具有肌肉减少症的模型）或列线图A（不具有肌肉减少症的模型）。结果显示，诺模图预测的1、3、5年生存率与实际观察值吻合较好，诺模图B预测的生存率（C指数= 0.77）显著高于诺模图A（0.676，P = 0.020）和TNM分期（0.604，P < 0.001）。危险组分层可以区分各个TNM分期的生存曲线（所有分期，P < 0.001; III期，P < 0.001; IV期，P = 0.002）。肌减少-EBVDNA列线图能更准确地预测鼻咽癌CCRT患者的预后。
The present study aimed to construct a prognostic nomogram including Epstein-Barr virus DNA (EBV-DNA) and sarcopenia in patients with nasopharyngeal carcinoma (NPC) receiving concurrent chemoradiotherapy (CCRT). In this retrospective analysis, we studied 1,045 patients with NPC who had been treated with CCRT between 2010 and 2014. Sarcopenia was determined using routine pre-radiotherapy computed tomography scans of the third cervical vertebrae. A new S-E grade was constructed using a receiver-operating characteristic (ROC) curve analyses determined cutoff values of sarcopenia and plasma EBV-DNA. The nomogram was developed base on the sarcopenia-EBV (S-E) grade and traditional prognostic factors. A calibration curve, time-dependent ROC, decision curve analysis, and the concordance index (C-index) determined the accuracy of prediction and discrimination of the nomogram, and were compared with TNM staging system and a traditional nomogram. Patient survival was significantly different when sarcopenia (P < 0.001) or EBV-DNA (P = 0.001) were used and they continued to be independent prognostic factors for survival upon univariate (P < 0.001, P = 0.002, respectively) and multivariate (P < 0.001, P = 0.015, respectively) analyses. Predicting overall survival (OS) was more accurate using the S-E grade than using TNM staging and sarcopenia or EBV-DNA alone. Nomogram B (model with sarcopenia) or nomogram A (model without sarcopenia) were then developed based on the identified independent prognostic factors. Comparing nomogram prediction with actual observation showed good agreement among the calibration curves for probability of 1-, 3-, and 5-year OS. Predicted survival (C-index = 0.77) of nomogram B was statistically higher than that of nomogram A (0.676, P = 0.020) and TNM staging (0.604, P < 0.001). Risk group stratification could distinguish between survival curves within respective TNM stages (all stages, P < 0.001; stage III, P < 0.001; stage IV, P = 0.002). The sarcopenia-EBV DNA nomogram allowed more accurate prediction of prognosis for patients with NPC receiving CCRT.
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