Study on the prognostic value of serological indicators for nasopharyngeal carcinoma based on nomogram model
10.3760/cma.j.cn371439-20230426-00089
- VernacularTitle:基于列线图模型探讨血清学指标对鼻咽癌预后的判断价值
- Author:
Xiao WANG
1
;
Ying LI
;
Yujie LUO
;
Shu JIN
Author Information
1. 四川省资阳市第一人民医院耳鼻咽喉头颈外科，资阳 641300
- Keywords:
Nasopharyngeal carcinoma;
Nomograms;
Prognosis;
Model
- From:
Journal of International Oncology
2023;50(8):463-469
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the prognostic value of serological indicators for nasopharyngeal carcinoma based on nomogram model.Methods:The clinal data of 231 patients diagnosed as nasopharyngeal carcinoma who were treated for the first time in the First People's Hospital of Ziyang of Sichuan Province from January 2020 to December 2021 were studied retrospectively. The patients were randomly divided into training group ( n=173) and verification group ( n=58) according to the ratio of 3∶1 by random number table method. Lasso Cox regression model was used to generate a prognosis model in the training cohort. Consistency index (C index) and decision curve analysis (DCA) were used to compare the prediction accuracy between the new prognosis model and TNM staging and Epstein-Barr virus (EBV) DNA copy number. Subsequently, an overall survival (OS) nomogram including prognosis model, TNM staging and EBV DNA copy number was established to predict the prognosis of nasopharyngeal carcinoma. Results:The median follow-up time of the training cohort was 31.4 months, and that of the verification cohort was 30.4 months. In the training cohort, the 12-month, 24-month and 36-month OS rates were 97.4%, 83.8% and 63.3% respectively. In the verification cohort, the 12-month, 24-month and 36-month OS rates were 94.2%, 84.4% and 72.8% respectively. There was no significant difference in the distribution of clinical features and serological indicators between the training cohort and the verification cohort (all P>0.05). The established prognostic model included the following variables: age, body mass index, platelet, lymphocyte/monocyte ratio, C-reactive protein (CRP), CRP/albumin ratio, globulin, albumin/globulin ratio and prognostic nutrition index. In the training cohort, the C index of the prognostic model was 0.790 (95% CI: 0.730-0.852), which was significantly higher than that of EBV DNA copy number (0.693, 95% CI: 0.625-0.760) ( χ2=5.74, P=0.028), but there was no significant difference compared to TNM staging (0.738, 95% CI: 0.688-0.786) ( χ2=2.32, P=0.074). In the validation cohort, the C index of the prognostic model (0.797, 95% CI: 0.742-0.874) was significantly higher than the DNA copy number of EBV (0.636, 95% CI: 0.559-0.713) ( χ2=6.03, P=0.024), but there was no significant difference compared to TNM staging (0.755, 95% CI: 0.705-0.815) ( χ2=1.74, P=0.121). DCA showed that the prognostic model had a better overall net benefit than EBV DNA copy number and was comparable to TNM staging in both the training and validation cohorts. The calibration curve of the training cohort and the verification cohort showed that the 12-month, 24-month and 36-month OS rates predicted by the nomograms were consistent with actual observations. Conclusion:The prognosis model established in this study, including serological indicators, shows better accuracy in predicting the prognosis of nasopharyngeal carcinoma than traditional TNM staging and EBV DNA copy number alone. The nomogram based on prognosis model, TNM staging and EBV DNA can enhance the predictive ability of prognosis model.
