Development and Validation of a Practical Score to Predict 3-year Distant Metastatic Free Survival in Nasopharyngeal Carcinoma Incorporating the Number of Lymph Node Regions

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Aug 27

PMID 39190649

Authors

Thitiporn Jaruthien

Chawalit Lertbutsayanukul

Nutchawan Jittapiromsak

Aniwat Sriyook

Prapasri Kulalert

Pichaya Tantiyavarong

Sarin Kitpanit

Danita Kannarunimit

Chakkapong Chakkabat

Anussara Prayongrat

Affiliations

Soon will be listed here.

Abstract

Introduction: The improvement in diagnosis and treatment for nasopharyngeal carcinoma (NPC) has shifted the pattern of failure toward distant metastasis. This study aimed to develop a simplified prognostic scoring model to predict distant metastatic free survival (DMFS) for NPC patients.

Materials And Methods: Patients with non-metastatic NPC were identified from a retrospective cohort diagnosed between 2010 and 2018. Flexible parametric survival analysis was used to identify potential predictors for DMFS and establish a scoring model. The prognostic accuracy between the 8th AJCC system and the scoring model was compared using Harrell's C-index.

Results: Of the total 393 patients, the median follow-up time was 85 months. The 3-year DMFS rate was 83.3%. Gender, T-stage, pre-EBV (cut-off 2300 copies/ml), and the number of metastatic lymph node regions were identified as independent risk factors for distant metastasis and were included in the final scoring model. Our established model achieved a high C-index in predicting DMFS (0.79) and was well-calibrated. The score divided patients into two categories: low-risk (score 0-4) and high-risk (score 5-7), corresponding with the predicted 3-year DMFS of 96% and 64.5%, respectively.

Conclusions: A feasible and applicative prognostic score was established and validated to discriminate NPC patients into low- and high-risk groups.

References

Intarak S, Chongpison Y, Vimolnoch M, Oonsiri S, Kitpanit S, Prayongrat A . Tumor Prognostic Prediction of Nasopharyngeal Carcinoma Using CT-Based Radiomics in Non-Chinese Patients. Front Oncol. 2022; 12:775248. PMC: 8831248. DOI: 10.3389/fonc.2022.775248. View

Guo Q, Lu T, Huang S, OSullivan B, Zong J, Xiao Y . Depicting distant metastatic risk by refined subgroups derived from the 8th edition nasopharyngeal carcinoma TNM. Oral Oncol. 2019; 91:113-120. DOI: 10.1016/j.oraloncology.2019.02.021. View

Zhang L, Dong D, Li H, Tian J, Ouyang F, Mo X . Development and validation of a magnetic resonance imaging-based model for the prediction of distant metastasis before initial treatment of nasopharyngeal carcinoma: A retrospective cohort study. EBioMedicine. 2019; 40:327-335. PMC: 6413336. DOI: 10.1016/j.ebiom.2019.01.013. View

Xiao G, Cao Y, Qiu X, Wang W, Wang Y . Influence of gender and age on the survival of patients with nasopharyngeal carcinoma. BMC Cancer. 2013; 13:226. PMC: 3672024. DOI: 10.1186/1471-2407-13-226. View

Zhou X, Ou X, Yang Y, Xu T, Shen C, Ding J . Quantitative Metastatic Lymph Node Regions on Magnetic Resonance Imaging Are Superior to AJCC N Classification for the Prognosis of Nasopharyngeal Carcinoma. J Oncol. 2019; 2018:9172585. PMC: 6304546. DOI: 10.1155/2018/9172585. View

Tang X, Li Y, Liang S, Jiang W, Liu F, Ge W . Development and validation of a gene expression-based signature to predict distant metastasis in locoregionally advanced nasopharyngeal carcinoma: a retrospective, multicentre, cohort study. Lancet Oncol. 2018; 19(3):382-393. DOI: 10.1016/S1470-2045(18)30080-9. View

Li Q, Mao Y, Guo R, Huang C, Fang X, Ma J . A Nomogram Based on Serum Biomarkers and Clinical Characteristics to Predict Survival in Patients With Non-Metastatic Nasopharyngeal Carcinoma. Front Oncol. 2020; 10:594363. PMC: 7758498. DOI: 10.3389/fonc.2020.594363. View

Chen F, Zhou G, Qi Z, Lin L, Hu J, Wang X . Prognostic value of cervical nodal tumor volume in nasopharyngeal carcinoma: Analysis of 1230 patients with positive cervical nodal metastasis. PLoS One. 2017; 12(5):e0176995. PMC: 5425204. DOI: 10.1371/journal.pone.0176995. View

Xie C, Li H, Yan Y, Liang S, Li Y, Liu L . A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma. Front Oncol. 2020; 10:616. PMC: 7273517. DOI: 10.3389/fonc.2020.00616. View

10.

Chen Y, Ismaila N, Chua M, Colevas A, Haddad R, Huang S . Chemotherapy in Combination With Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline. J Clin Oncol. 2021; 39(7):840-859. DOI: 10.1200/JCO.20.03237. View

11.

Lu T, Hu Y, Xiao Y, Guo Q, Huang S, OSullivan B . Prognostic value of radiologic extranodal extension and its potential role in future N classification for nasopharyngeal carcinoma. Oral Oncol. 2019; 99:104438. DOI: 10.1016/j.oraloncology.2019.09.030. View

12.

Alami I, Gihbid A, Charoute H, Khaali W, Brahim S, Tawfiq N . Prognostic value of Epstein-Barr virus DNA load in nasopharyngeal carcinoma: a meta-analysis. Pan Afr Med J. 2022; 41:6. PMC: 8797042. DOI: 10.11604/pamj.2022.41.6.28946. View

13.

Zhang J, Shu C, Song Y, Li Q, Huang J, Ma X . Epstein-Barr virus DNA level as a novel prognostic factor in nasopharyngeal carcinoma: A meta-analysis. Medicine (Baltimore). 2016; 95(40):e5130. PMC: 5059099. DOI: 10.1097/MD.0000000000005130. View

14.

Lertbutsayanukul C, Kannarunimit D, Prayongrat A, Chakkabat C, Kitpanit S, Hansasuta P . Prognostic Value of Plasma EBV DNA for Nasopharyngeal Cancer Patients during Treatment with Intensity-modulated Radiation Therapy and Concurrent Chemotherapy. Radiol Oncol. 2018; 52(2):195-203. PMC: 6043877. DOI: 10.2478/raon-2018-0016. View

15.

Au K, Ngan R, Ng A, Poon D, Ng W, Yuen K . Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong: A report of 3328 patients (HKNPCSG 1301 study). Oral Oncol. 2018; 77:16-21. DOI: 10.1016/j.oraloncology.2017.12.004. View

16.

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

17.

Ho A, Kim S, Tighiouart M, Gudino C, Mita A, Scher K . Association of Quantitative Metastatic Lymph Node Burden With Survival in Hypopharyngeal and Laryngeal Cancer. JAMA Oncol. 2017; 4(7):985-989. PMC: 6584272. DOI: 10.1001/jamaoncol.2017.3852. View

18.

Zeng L, Guo P, Li J, Han F, Li Q, Lu Y . Prognostic score models for survival of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy and chemotherapy. Oncotarget. 2015; 6(36):39373-83. PMC: 4770779. DOI: 10.18632/oncotarget.5781. View

19.

Zhang Y, Li W, Mao Y, Zhou G, Peng H, Sun Y . Establishment of an integrated model incorporating standardised uptake value and N-classification for predicting metastasis in nasopharyngeal carcinoma. Oncotarget. 2016; 7(12):13612-20. PMC: 4924665. DOI: 10.18632/oncotarget.7253. View

20.

Ho A, Kim S, Tighiouart M, Gudino C, Mita A, Scher K . Metastatic Lymph Node Burden and Survival in Oral Cavity Cancer. J Clin Oncol. 2017; 35(31):3601-3609. PMC: 5791830. DOI: 10.1200/JCO.2016.71.1176. View