Cancer Res Treat.  2018 Oct;50(4):1084-1095. 10.4143/crt.2017.359.

Proposal of a Pretreatment Nomogram for Predicting Local Recurrence after Intensity-Modulated Radiation Therapy in T4 Nasopharyngeal Carcinoma: A Retrospective Review of 415 Chinese Patients

• Zhang LL
• Li YY
• Hu J
• Zhou GQ
• Chen L
• Li WF
• Lin AH
• Ma J
• Qi ZY
• Sun Y

• KMID: 2424781
• DOI: http://doi.org/10.4143/crt.2017.359

Abstract

PURPOSE
Local relapse-free survival (LRFS) differs widely among patients with T4 category nasopharyngeal carcinoma (NPC). We aimed to build a nomogram incorporating clinicopathological information to predict LRFS in T4 NPC after definitive intensity-modulated radiation therapy (IMRT).
MATERIALS AND METHODS
Retrospective study of 415 Chinese patients with non-metastatic T4 NPC treated with definitive IMRT with or without chemotherapy at our cancer center between October 2009 and September 2013. The nomogram for LRFS at 3 and 5 years was generated based on multivariate Cox proportional hazards regression, and validated using bootstrap resampling, assessing discriminative performance using the concordance index (C-index) and determining calibration ability via calibration curves.
RESULTS
Five-year LRFS was 88.8%. We identified and incorporated four independent prognostic factors for LRFS: ethmoid sinus invasion, primary gross tumor volume, age, and pretreatment body mass index. The C-index of the nomogram for local recurrence was 0.732 (95% confidence interval, 0.726 to 0.738), indicating excellent predictive accuracy. The calibration curve revealed excellent agreement between nomogram-predicted and observed LRFS probabilities. Risk subgroups based on total point score cutoff values enabled effective discrimination of LRFS.
CONCLUSION
This pretreatment nomogram enables clinicians to accurately predict LRFS in T4 NPC after definitive IMRT, and could help to facilitate personalized patient counselling and treatment strategies.

Keyword

Intensity-modulated radiation therapy; Recurrence; Nasopharyngeal carcinoma; Nomograms

MeSH Terms

Asian Continental Ancestry Group*
Body Mass Index
Calibration
Discrimination (Psychology)
Drug Therapy
Ethmoid Sinus
Humans
Nomograms*
Recurrence*
Retrospective Studies*
Tumor Burden

Figure

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  Fig. 1. Nomogram for local recurrence in non-metastatic T4 nasopharyngeal carcinoma after radical intensity-modulated radiation therapy. BMI, body mass index; GTVp, primary gross tumor volume.

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  Fig. 2. Calibration curves for predicting local recurrence at 3 years (A) and 5 years (B). Nomogram-predicted probability of local recurrence is plotted on the x-axis; actual observed local recurrence-free probability is plotted on the y-axis.

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  Fig. 3. Kaplan-Meier local recurrence-free survival curves for patients with T4 nasopharyngeal carcinoma based on risk group stratification. Patients were classified into a low-risk group (score < 123), intermediate-risk group (123- 202), and high-risk group (203-325) using total nomogram point score cutoff values determined using X-tile software.

Reference

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