Prognostic Nomogram for Patients with Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy.

This study was aimed to define possible predictors of overall survival in nasopharyngeal carcinoma (NPC). Patients were treated with intensity-modulated radiation therapy (IMRT), to establish an effective prognostic nomogram that could provide individualized predictions of treatment outcome in this setting. We reviewed the records of 533 patients with non-metastatic NPC who underwent IMRT with or without concurrent chemotherapy at the Department of Radiation Oncology of Sun Yat-Sen University from 2002 to 2009; none of these patients received induction or adjuvant chemotherapy. These data sets were used to construct a nomogram based on Cox regression. Nomogram performance was determined via a concordance index (C-index) and a calibration curve which was compared with the TNM staging system for NPC. The results were validated in an external cohort of 442 patients from the Department of Radiation Oncology of Wenzhou Medical College who were treated during the same period. Results showed that the greatest influence on survival were primary gross tumor volume, age, tumor stage and nodal stage (2002 Union for International Cancer Control [UICC] staging system), which were selected into the nomogram. The C-index of the nomogram for predicting survival was 0.748 (95%CI, 0.704-0.785), which was statistically higher than that of TNM staging system (0.684, P<0.001). The calibration curve exhibited agreement between nomogram-predicted and the actual observed probabilities for overall survival. In the validation cohort, the nomogram discrimination was superior to the TNM staging system (C-index: 0.768 vs 0.721; P = 0.026). In conclusion, the nomogram proposed in this study resulted in more-accurate prognostic prediction for patients with NPC after IMRT and compared favorably to the TNM staging system; this individualized information will aid in patient counseling and may be used for de-escalation trials in the future

Multivariate analyses of overall survival with Cox proportional hazards model for patients with nasopharyngeal carcinoma in the training cohort (<i>N</i> = 533).

<p>Abbreviations: T stage, clinical tumor stage; N stage, clinical nodal stage; GTV, gross tumor volume; HR, hazard ratio.</p><p>Multivariate analyses of overall survival with Cox proportional hazards model for patients with nasopharyngeal carcinoma in the training cohort (<i>N</i> = 533).</p

(A) Calibration curves for 5-year probabilities of overall survival in the training cohort of 533 patients and (B) the validation cohort of 442 patients.

<p>Patients were grouped by quartiles of predicted risk. Nomogram-predicted probability is plotted on the x-axis; observed probability is plotted on the y-axis (Kaplan-Meier estimates). Vertical bars = 95% confidence index.</p

The nomogram developed for the 5-year prediction of overall survival.

<p>Point scores for gross tumor volume (GTV) were identified based on the T stage. To estimate risk, points for each variable were calculated by drawing a straight line from a patient’s variable value to the axis labeled “Points.” The score sum is converted to a probability in the lowest axis.</p

Multivariate analyses of overall survival with Cox proportional hazards model for patients with nasopharyngeal carcinoma in the training cohort (<i>N</i> = 533).

<p>Abbreviations: T stage, clinical tumor stage; N stage, clinical nodal stage; GTV, gross tumor volume; HR, hazard ratio.</p><p>Multivariate analyses of overall survival with Cox proportional hazards model for patients with nasopharyngeal carcinoma in the training cohort (<i>N</i> = 533).</p