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. 2016 Nov 15;122(21):3307-3315.
doi: 10.1002/cncr.30198. Epub 2016 Jul 19.

Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy

Jian Ji Pan  1   2 , Wai Tong Ng  3 , Jing Feng Zong  1   2 , Sarah W M Lee  3 , Horace C W Choi  4 , Lucy L K Chan  3 , Shao Jun Lin  1   2 , Qiao Juan Guo  1   2 , Henry C K Sze  3 , Yun Bin Chen  5 , You Ping Xiao  5 , Wai Kuen Kan  6 , Brian O'Sullivan  7 , Wei Xu  8 , Quynh Thu Le  9 , Christine M Glastonbury  10 , A Dimitrios Colevas  11 , Randal S Weber  12 , William Lydiatt  13 , Jatin P Shah  14 , Anne W M Lee  15
Affiliations

Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy

Jian Ji Pan et al. Cancer. .

Abstract

Background: The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system.

Methods: Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups.

Results: A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively.

Conclusions: The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307-3315. © 2016 American Cancer Society.

Keywords: TNM staging; intensity-modulated radiotherapy; nasopharyngeal carcinoma; nomogram; prognostication.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

None of the authors have any potential conflict of interest.

Figures

Figure 1
Figure 1
Nomogram for 5-year and 8-year overall survival (OS) based on the training cohort
Figure 2
Figure 2
Calibration plot for overall survival on (A) training cohort (intercept=−0.05, p=0.60; slope=1.06, p=0.59) and (B) validation cohort (intercept=0.15, p=0.25; slope=0.89, p=0.47)
Figure 3
Figure 3
Recursive partitioning algorithm for overall survival of the whole series based on the score derived from the nomogram
Figure 4
Figure 4
Kaplan-Meier plots for overall survival of the whole series (A) Stage-group by AJCC/UICC Proposed 8th Edition, (B) risk-groups by nomogram
See this image and copyright information in PMC

Comment in

References

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