PO-1012 proposal of new N stage scheme and comparison between seven N schemes in nasopharyngeal carcinoma

Abstract Objective To view and evaluate the prognosis factors in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy using nomogram and decision curve analysis (DCA). Methods Based on a primary cohort comprising consecutive patients with newly confirmed NPC (n = 1140) treated between January 2014 and December 2015, we identified independent prognostic factors of overall survival (OS) to establish a nomogram. The model was assessed by bootstrap internal validation and external validation in an independent validation cohort of 460 patients treated between January 2013 and December 2013. The predictive accuracy and discriminative ability were measured by calibration curve, concordance index (C-index) and risk-group stratification. The clinical usefulness was assessed by DCA. Results The nomogram incorporated T-stage, N-stage, age, concurrent chemotherapy and primary tumour volume (PTV). The calibration curve presented good agreement for between the nomogram-predicted OS and the actual measured survival probability in both the primary and validation cohorts. The model showed good discrimination with a C-index of 0.741 in the primary cohort and 0.762 in the validation cohort. The survival curves of different risk-groups were separated clearly. Decision curve analysis demonstrated that the nomogram provided a higher net benefit (NB) across a wider reasonable range of threshold probabilities for predicting OS. Conclusion This study presents a predictive nomogram model with accurate prediction and independent discrimination ability compared with combination of T-stage and N-stage. The results of DCA supported the point that PTV can help improve the prognostic ability of T-stage and should be added to the TNM staging system.

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Hematological Indexes Can Be Used to Predict the Incidence of Hypothyroidism in Nasopharyngeal Carcinoma Patients after Radiotherapy

BioMed Research International ◽

10.1155/2020/3860936 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Ling Zhou ◽

Jia Chen ◽

Chang-Juan Tao ◽

Shuang Huang ◽

Jiang Zhang ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Predictive Model ◽

Immune Cells ◽

Cross Validation ◽

Complete Blood Count ◽

Univariate Analysis ◽

Optimal Method ◽

Internal Validation ◽

N Stage ◽

Tenfold Cross Validation

Background. This study explored the relationship between thyroid-associated antibodies, immune cells, and hypothyroidism to establish a predictive model for the incidence of hypothyroidism in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods. A total of 170 patients with NPC treated at the Cancer Hospital of University of Chinese Academy of Sciences between January 2015 and August 2018 were included. The complete blood count, biochemical, coagulation function, immune cells, and thyroid-associated antibodies tested before radiotherapy were evaluated. A logistic regression model was performed to elucidate which hematological indexes were related to hypothyroidism development. A predictive model for the incidence of hypothyroidism was established. Internal verification of the multifactor model was performed using the tenfold cross-validation method. Results. The univariate analysis showed that immune cells had no statistically significant differences among the patients with and without hypothyroidism. Sex, N-stage, antithyroid peroxidase antibody (TPO-Ab), antithyroglobulin antibody (TG-Ab), thyroglobulin (TG), and fibrinogen (Fb) were associated with hypothyroidism. Males and early N-stage were protective factors of thyroid function, whereas increases in TPO-Ab, TG-Ab, TG, and Fb counts were associated with an increased rate of hypothyroidism incidence. The multivariate analysis showed that TPO-Ab, TG-Ab, TG, and Fb were independent predictors of hypothyroidism. The comprehensive effect of the significant model, including TPO-Ab, TG-Ab, TG, and Fb counts, represented the optimal method of predicting the incidence of radiation-induced hypothyroidism (AUC=0.796). Tenfold cross-validation methods were applied for internal validation. The AUCs of the training and testing sets were 0.792 and 0.798, respectively. Conclusion. A model combining TPO-Ab, TG-Ab, TG, and Fb can be used to screen populations at a high risk of developing hypothyroidism after radiotherapy.

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Analysis of Prognostic Risk Factors in Patients with Nasopharyngeal Carcinoma Treated with Radiotherapy by Magnetic Resonance Imaging

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.3137 ◽

2020 ◽

Vol 10 (9) ◽

pp. 2079-2083

Author(s):

Jie Qi ◽

Mang Xiao ◽

Sharma Vikas

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Survival Rate ◽

Magnetic Resonance ◽

Nasopharyngeal Carcinoma ◽

Resonance Imaging ◽

Residual Rate ◽

Free Survival ◽

N Stage ◽

Prognostic Risk Factors

The purpose of the study was to explore the application value of magnetic resonance imaging (MRI) technology in the study of the prognosis of patients with nasopharyngeal carcinoma (NPC) after radiotherapy, and to analyze the risk factors leading to imaging residues, so as to provide reference for the treatment and prognosis of patients with NPC. The clinical data of 691 patients with NPC hospitalized from June 2008 to June 2016 were retrospectively analyzed. According to the results of magnetic resonance medical imaging, the residual data of patients with NPC after treatment were analyzed. Combined with t-stage and n-stage parameters, the image residual was divided into t-stage residual and n-stage residual. The radiological residues, residual regression time, survival time, recurrence and metastasis time were recorded. The radiological residual rate of NPC after radiotherapy was calculated, and the differences among groups were compared by chi-square test. The risk factors of image residual and residual regression time were analyzed by logistic regression model. The 5-year overall survival rate (OS), 5-year recurrence-free survival rate (LRFS), and 5-year distant metastasis-free survival rate (DMF) were calculated. Kaplan.Meier method was used to analyze the influence of various factors on the prognosis of patients, and logarithmic rank test was used to compare the difference of survival rate between the two groups. The results showed that the residual rate of T and N was 32.9% and 31.0% at the end of radiotherapy for NPC. In summary, magnetic resonance medical imaging technology can effectively evaluate the prognostic risk factors of patients with NPC after radiotherapy. Male, elderly, radioactivity residue, and high stage are the risk factors affecting the prognosis of patients with NPC after radiotherapy. The recurrence and metastasis of NPC patients can be effectively controlled by means of emphasizing radiotherapy combined with adjuvant chemotherapy.

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Maximal lymph nodal diameter on N stage of nasopharyngeal carcinoma

Medicine ◽

10.1097/md.0000000000026543 ◽

2021 ◽

Vol 100 (26) ◽

pp. e26543

Author(s):

Shi-Ting Huang ◽

Song Qu ◽

Ling Li ◽

Kai-Hua Chen ◽

Xiao-Dong Zhu ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Nodal Diameter ◽

N Stage

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The Value of Cervical Node Features in Predicting Long-Term Survival of Nasopharyngeal Carcinoma in Intensity-Modulated Radiotherapy Era

10.21203/rs.3.rs-109566/v1 ◽

2020 ◽

Author(s):

Yunming Tian ◽

Lei Zeng ◽

Runda Huang ◽

Yuhong Lan ◽

Xia Yuan ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Prognostic Value ◽

Intensity Modulated Radiotherapy ◽

Distant Metastases ◽

Term Survival ◽

Intensity Modulated ◽

Cervical Node ◽

Extranodal Extension ◽

N Stage ◽

Multivariate Proportional Hazard

Abstract The prognostic value of cervical node features in nasopharyngeal carcinoma(NPC) patients treated with intensity-modulated radiotherapy (IMRT) was controversial. In this study, about 1752 patients after IMRT from 2008 to 2011 were recruited. The nodal features including the nodal number, maximize dimension diameter, extranodal extension(ENE)and cervical node necrosis(CNN) were retrospective analyzed. Univariate Cox and multivariate proportional hazard regression models were used to test the prognostic value of nodal features. Prognostic nomograms were built to predict the survival. The 10-year distant metastases free survival (DMFS) and disease-specific survival(DSS) rates were 86.5% and 80.8%. By multivariate analysis, the independent factors for the DSS were gender, age, lactate dehydrogenase (LDH), CNN, ENE, T stage and N stage. Nomogram A (without nodal features ) and nomogram B (with nodal features) were built. The calibration curve for the probability of DSS showed good agreement between prediction by nomogram and actual observation.The C-index of nomogram B was higher than for nomogram A in predicting DSS ( 0.708 vs 0.676,P <.01). These results demonstrated the nodal features including the ENE and CNN were negative prognostic factors in patients with NPC, and the prognostic nomogram incorporating the nodal features was more accurate.

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Prognostic and clinicopathological value of Ki-67 expression in patients with nasopharyngeal carcinoma: a meta-analysis

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920951346 ◽

2020 ◽

Vol 12 ◽

pp. 175883592095134

Author(s):

Zhaohui Shi ◽

Weihong Jiang ◽

Xiaodong Chen ◽

Min Xu ◽

Xiaocheng Wang ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Meta Analysis ◽

Progression Free Survival ◽

Cochrane Library ◽

Poor Overall Survival ◽

Ki 67 ◽

Free Survival ◽

Hazard Ratios ◽

N Stage

Background: This meta-analysis aimed to identify the prognostic role of Ki-67 in patients with nasopharyngeal carcinoma (NPC). Methods: Relevant studies were retrieved in the PubMed, Embase, Web of Science, and Cochrane Library databases up to November 2019. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to estimate the association between Ki-67 expression and survival outcomes. Combined odds ratios (ORs) and 95% CIs were measured as effect size on the association between Ki-67 expression and clinical factors. Results: A total of eight studies involving 936 patients with NPC were included in this meta-analysis. The pooled HR indicated that Ki-67 expression was significantly associated with poor overall survival (HR = 2.86, 95% CI = 1.91–4.27, p < 0.001), progression-free survival (HR = 1.78, 95% CI = 1.15–2.74, p = 0.009), and distant metastasis-free survival (HR = 1.65, 95% CI = 1.15–2.36, p = 0.007). However, there was no significant correlation between Ki-67 expression and local recurrence-free survival (HR = 1.07, 95% CI = 0.54–2.14, p = 0.843). Ki-67 overexpression was associated with higher T stage (OR = 1.48, 95% CI = 1.00–2.20, p = 0.052), and the relationship between Ki-67 expression and advanced stage was nearly significant (OR = 2.25, 95% CI = 0.99–5.14, p = 0.054). However, high Ki-67 expression was not significantly correlated with sex, age, N stage, or histological type. Conclusion: This meta-analysis demonstrated that Ki-67 overexpression was a significant marker for poor prognosis in patients with NPC. Ki-67 should be recommended as a useful index for prognostication in patients with NPC.

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Clinical outcomes of patients with nasopharyngeal carcinoma treated with antibiotics for radiation-induced mucositis: a retrospective study

Journal of International Medical Research ◽

10.1177/0300060519874899 ◽

2019 ◽

Vol 48 (3) ◽

pp. 030006051987489

Author(s):

JingJin Weng ◽

Jiazhang Wei ◽

Min Li ◽

Jinlong Lu ◽

Yangda Qin ◽

...

Keyword(s):

Multivariate Analysis ◽

Nasopharyngeal Carcinoma ◽

Disease Free Survival ◽

Survival Curves ◽

Free Survival ◽

Factors Affecting ◽

Radiation Induced ◽

N Stage ◽

Grade 3 ◽

Disease Free

Objective To examine the effects of antibiotic administration on radiation-induced oral and oropharyngeal mucositis, and on the prognosis of patients with nasopharyngeal carcinoma (NPC). Methods We retrospectively analyzed data for patients with NPC with grade 1/2 or 3/4 mucositis. Forty-two patients with grade 3/4 mucositis received antibiotics. Univariate survival analysis was assessed by Kaplan–Meier survival curves, survival curves were compared using log-rank tests, and multivariate analysis was carried out by Cox regression. Results A total of 463 patients with NPC were included in the study (194 grade 1/2 mucositis, 269 grade 3/4 mucositis). Univariate analyses identified T-stage, N-stage, clinical stage, type of treatment, and antibiotic use as factors affecting overall and disease-free survival. Multivariate analysis also determined that T-stage, N-stage stage, type of treatment, and antibiotic usage were independent factors affecting overall and disease-free survival. Mucositis improved in 32 of the 42 patients who received antibiotics (76.19%). However, red blood cell count and hemoglobin levels decreased in all patients after antibiotic treatment. Conclusions Antibiotics may be effective for the treatment of severe radiation-induced mucositis (grade 3/4) during chemoradiotherapy, but may potentially adversely affect the prognosis of patients with NPC.

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Analysis of Prognostic Factors of Nasopharyngeal Carcinoma and Construction of Risk Nomogram Prediction Model

10.21203/rs.3.rs-645804/v1 ◽

2021 ◽

Author(s):

xuan hao zhang ◽

LU Jin ◽

JIANG Cheng-yi ◽

FANG Mei-fang ◽

Liu Hai-rong

Keyword(s):

Prognostic Factors ◽

Nasopharyngeal Carcinoma ◽

Prediction Model ◽

Predictive Model ◽

Older Age ◽

Predictive Values ◽

Clinical Prognosis ◽

Cox Regression Analysis ◽

N Stage ◽

Degree Of Differentiation

Abstract Objective To analyze the factors affecting the prognosis of nasopharyngeal carcinoma (NPC) patients and establish a risk nomogram prediction model for the diagnosis, treatment and prognosis of NPC. Methods A total of 1645 NPC patients (1470 survival) from 1973 to 2015 in the SEER database were included. The clinicopathological data of 180 NPC patients hospitalized in the First Affiliated Hospital of Bengbu Medical College since 2010 were collected. The spearman correlation analysis and COX regression analysis were used to identify the prognostic factors of NPC and establish the risk nomogram prediction model. Receiver operation characteristic (ROC) analysis and area under curves (AUC) were used to evaluate the ability of distinguishing the prognosis of NPC patients. The cross calibration was calculated to evaluate the external validation of established predictive model.Results The survival NPC had higher proportion in female, older age, degree of NPC differentiation, N and M stage (all P<0.05. The study factors including female, older age, and higher degree of differentiation were positively correlated with the prognosis of NPC patients (P<0.05), while N and M stage were negatively correlated with the prognosis of NPC patients (P<0.05). The factors including female (HR=4.92, 95%CI 3.58-6.75), age (HR=, 95%CI=), degree of differentiation (HR=, 95%CI=), N stage (HR=, 95%CI=) were independently associated with prognosis of NPC patients (P<0.05). Comparing with calibration curve, the constructed risk prediction model had good relations between predictive values and actual values (AUC=0.833). Additionally, the external verification results of 96 patients with NPC had a larger AUC in our established predictive model (AUC=0.851). Conclusions Female, degree of differentiation and N stage are independent factors for the prognosis of NPC patients. The risk nomogram prediction model has a good predictive ability for the survival of NPC patients, which can provide important insights into clinical prognosis for NPC patients.

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