J Cancer 2017; 8(13):2595-2603. doi:10.7150/jca.20255

Research Paper

Pretreatment Nomograms for Local and Regional Recurrence after Radical Radiation Therapy for Primary Nasopharyngeal Carcinoma

Fo-ping Chen1*, Li Lin1*, Zhen-yu Qi1, Guan-qun Zhou1, Rui Guo1, Jiang Hu1, Ai-Hua Lin2, Jun Ma1✉, Ying Sun 1✉

1. State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510060, People's Republic of China;
2. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
* These authors contributed equally to this work.

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Chen Fp, Lin L, Qi Zy, Zhou Gq, Guo R, Hu J, Lin AH, Ma J, Sun Y. Pretreatment Nomograms for Local and Regional Recurrence after Radical Radiation Therapy for Primary Nasopharyngeal Carcinoma. J Cancer 2017; 8(13):2595-2603. doi:10.7150/jca.20255. Available from https://www.jcancer.org/v08p2595.htm

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Background: The aim of this study was to build nomograms to predict local recurrence (LR) and regional recurrence (RR) in patients with nasopharyngeal carcinoma (NPC) underwent intensity-modulated radiation therapy (IMRT).

Patients and Methods: A total of 1811 patients with non-metastatic NPC treated with IMRT (with or without chemotherapy) between October 2009 and February 2012 at our center were involved for building the nomograms. Nomograms for LR-free rate and RR-free rate at 3- and 5- year were generated as visualizations of Cox proportional hazards regression models, and validated using bootstrap resampling, estimating discrimination and calibration.

Results: With a median follow up of 49.50 months, the 3- and 5- year LR-free rate were 95.43% and 94.30% respectively; the 3- and 5- year RR-free rate were 95.94% and 95.41% respectively. The final predictive model for LR included age, the neutrophil/leukocyte ratio (NWR), pathological type, primary gross tumor volume, maxillary sinus invasion, ethmoidal sinus invasion and lacerated foramen invasion; the model for RR involved NWR, plasma Epstein-Barr virus (EBV) DNA copy number, cervical lymph node volume and N category. The models showed fairly good discriminatory ability with concordance indices (c-indices) of 0.76 and 0.74 for predicting LR and RR, respectively, as well as good calibration. The proposed stratification of risk groups based on the nomograms allowed significant distinction between Kaplan-Meier curves for LR and RR.

Conclusions: The proposed nomograms resulted in more-accurate prognostic prediction for LR and RR with a high concordance, hence to inform patients with high risk of recurrence on more aggressive therapy. The prognostic nomograms could better stratify patients into different risk groups.

Keywords: Nomogram, Local Recurrence, Regional Recurrence, Nasopharyngeal Carcinoma, Intensity-Modulated Radiation Therapy.