A Nomogram for the Prediction of Prognosis in Patients With Distant Metastases of Nasopharyngeal Carcinoma

Overview

Journal Front Oncol

Specialty Oncology

Date 2019 Apr 27

PMID 31024844

Citations 2

Authors

Liang Zhao

Qiuming Lin

Jianwei Gu

Huan Zhang

Haojun Chen

Qin Lin

Affiliations

Soon will be listed here.

Abstract

Patients with metastatic nasopharyngeal carcinoma (NPC) have heterogeneous survival outcomes. This study aimed to establish an effective prognostic nomogram for patients with NPC with distant metastases using easily determined factors. The nomogram was based on a retrospective study of 103 patients with metastatic NPC at the First Affiliated Hospital of Xiamen University during January 2009-March 2016. Nomogram performance was evaluated using a concordance index (C-index) and assessed using calibration plot. Bootstraps with 1,000 resamples were applied to these analyses. In univariate and multivariate Cox proportional hazards model analyses, chemotherapy, metastatic liver involvement, number of tumor metastases, N stage and derived neutrophil-lymphocyte ratio correlated with overall survival (OS). The recurrence probability calibration curve indicated good agreement between nomogram-based predictions and actual observations. For OS predictions, the nomogram had a C-index of 0.824 (95% confidence interval, 0.74-0.91). The stratification by nomogram score of patients into different subgroups showed significant distinction. This novel nomogram comprises factors that are easily determined at most hospitals and can predict survival in patients with distant metastases of NPC. This model can precisely estimate the survival of individual patients and identify subgroups of patients requiring specific therapeutic strategies.

Citing Articles

The prognostic value of boost dose in residual cervical lymph nodes in nasopharyngeal carcinoma patients after intensity-modulated radiotherapy: a retrospective study.

Xu M, Wang L, Ding J, Xu Y, Fei Z BMC Cancer. 2025; 25(1):222.

PMID: 39920660 PMC: 11806820. DOI: 10.1186/s12885-025-13665-4.

Patterns of failure and prognosis in nasopharyngeal carcinoma according to Epstein-Barr virus DNA status.

Guo L, Lu G, Lu Z, Yu Y, Wu S Infect Agent Cancer. 2025; 20(1):6.

PMID: 39905518 PMC: 11796219. DOI: 10.1186/s13027-024-00631-1.

Nomogram Predicting the Benefits of Adding Concurrent Chemotherapy to Intensity-Modulated Radiotherapy After Induction Chemotherapy in Stages II-IVb Nasopharyngeal Carcinoma.

Liu S, Sun X, Lu Z, Chen Q, Lin H, Tang L Front Oncol. 2020; 10:539321.

PMID: 33240805 PMC: 7681000. DOI: 10.3389/fonc.2020.539321.

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

Qu W, Li S, Zhang M, Qiao Q Cancer Med. 2020; 9(17):6147-6158.

PMID: 32649056 PMC: 7476823. DOI: 10.1002/cam4.3301.

References

Lin J, Chen K, Wang W, Jan J, Liang W, Tsai C . Detection of Epstein-Barr virus DNA in the peripheral-blood cells of patients with nasopharyngeal carcinoma: relationship to distant metastasis and survival. J Clin Oncol. 2001; 19(10):2607-15. DOI: 10.1200/JCO.2001.19.10.2607. View

Chiesa F, De Paoli F . Distant metastases from nasopharyngeal cancer. ORL J Otorhinolaryngol Relat Spec. 2001; 63(4):214-6. DOI: 10.1159/000055743. View

Ong Y, Heng D, Chung B, Leong S, Wee J, Fong K . Design of a prognostic index score for metastatic nasopharyngeal carcinoma. Eur J Cancer. 2003; 39(11):1535-41. DOI: 10.1016/s0959-8049(03)00310-1. View

Liu M, Hsieh C, Chang T, Lin J, Huang C, Wang A . Prognostic factors affecting the outcome of nasopharyngeal carcinoma. Jpn J Clin Oncol. 2003; 33(10):501-8. DOI: 10.1093/jjco/hyg092. View

Chua D, Sham J, Au G . A phase II study of docetaxel and cisplatin as first-line chemotherapy in patients with metastatic nasopharyngeal carcinoma. Oral Oncol. 2005; 41(6):589-95. DOI: 10.1016/j.oraloncology.2005.01.008. View

Chang E, Adami H . The enigmatic epidemiology of nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev. 2006; 15(10):1765-77. DOI: 10.1158/1055-9965.EPI-06-0353. View

Khanfir A, Frikha M, Ghorbel A, Drira M, Daoud J . Prognostic factors in metastatic nasopharyngeal carcinoma. Cancer Radiother. 2007; 11(8):461-4. DOI: 10.1016/j.canrad.2007.06.006. View

Li Y, Wang F, Jiang W, Xiang X, Deng Y, Hu G . Phase II study of capecitabine and cisplatin combination as first-line chemotherapy in Chinese patients with metastatic nasopharyngeal carcinoma. Cancer Chemother Pharmacol. 2008; 62(3):539-44. DOI: 10.1007/s00280-007-0641-2. View

Iasonos A, Schrag D, Raj G, Panageas K . How to build and interpret a nomogram for cancer prognosis. J Clin Oncol. 2008; 26(8):1364-70. DOI: 10.1200/JCO.2007.12.9791. View

10.

Wang W, Twu C, Chen H, Jan J, Jiang R, Chao J . Plasma EBV DNA clearance rate as a novel prognostic marker for metastatic/recurrent nasopharyngeal carcinoma. Clin Cancer Res. 2010; 16(3):1016-24. DOI: 10.1158/1078-0432.CCR-09-2796. View

11.

Razak A, Siu L, Liu F, Ito E, OSullivan B, Chan K . Nasopharyngeal carcinoma: the next challenges. Eur J Cancer. 2010; 46(11):1967-78. DOI: 10.1016/j.ejca.2010.04.004. View

12.

Bensouda Y, Kaikani W, Ahbeddou N, Rahhali R, Jabri M, Mrabti H . Treatment for metastatic nasopharyngeal carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis. 2010; 128(2):79-85. DOI: 10.1016/j.anorl.2010.10.003. View

13.

Pan C, Wu P, Yu J, Li W, Huang Z, Wang J . Comparative survival analysis in patients with pulmonary metastases from nasopharyngeal carcinoma treated with radiofrequency ablation. Eur J Radiol. 2011; 81(4):e473-7. DOI: 10.1016/j.ejrad.2011.05.037. View

14.

Pan C, Wu P, Yu J, Li W, Huang Z, He N . CT-guided radiofrequency ablation prolonged metastatic survival in patients with liver metastases from nasopharyngeal carcinoma. Int J Hyperthermia. 2011; 27(6):549-54. DOI: 10.3109/02656736.2011.593019. View

15.

Jin Y, Cai X, Cai Y, Cao Y, Xia Q, Tan Y . To build a prognostic score model containing indispensible tumour markers for metastatic nasopharyngeal carcinoma in an epidemic area. Eur J Cancer. 2011; 48(6):882-8. DOI: 10.1016/j.ejca.2011.09.004. View

16.

Liu N, Chen N, Cui R, Li W, Li Y, Wei R . Prognostic value of a microRNA signature in nasopharyngeal carcinoma: a microRNA expression analysis. Lancet Oncol. 2012; 13(6):633-41. DOI: 10.1016/S1470-2045(12)70102-X. View

17.

Jin Y, Shi Y, Cai X, Xia X, Cai Y, Cao Y . Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma. J Cancer Res Clin Oncol. 2012; 138(10):1717-25. DOI: 10.1007/s00432-012-1219-x. View

18.

Proctor M, McMillan D, Morrison D, Fletcher C, Horgan P, Clarke S . A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012; 107(4):695-9. PMC: 3419948. DOI: 10.1038/bjc.2012.292. View

19.

Pan C, Lu J, Yu J, Chen P, Li W, Huang Z . Challenges in the modification of the M1 stage of the TNM staging system for nasopharyngeal carcinoma: A study of 1027 cases and review of the literature. Exp Ther Med. 2012; 4(2):334-338. PMC: 3460246. DOI: 10.3892/etm.2012.584. View

20.

Pereira E, Jones D, Jung K, Padera T . The lymph node microenvironment and its role in the progression of metastatic cancer. Semin Cell Dev Biol. 2015; 38:98-105. PMC: 4397158. DOI: 10.1016/j.semcdb.2015.01.008. View