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. 2017 Sep 6;17(1):628.
doi: 10.1186/s12885-017-3630-9.

Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma

Lin Yang  1   2   3 , Liangping Xia  1   2   3 , Yan Wang  1   2   3 , Shasha He  1   2   3 , Haiyang Chen  4 , Shaobo Liang  5 , Peijian Peng  6 , Shaodong Hong  7   8   9 , Yong Chen  10   11   12
Affiliations

Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma

Lin Yang et al. BMC Cancer. .

Abstract

Background: The skeletal system is the most common site of distant metastasis in nasopharyngeal carcinoma (NPC); various prognostic factors have been reported for skeletal metastasis, though most studies have focused on a single factor. We aimed to establish nomograms to effectively predict skeletal metastasis at initial diagnosis (SMAD) and skeletal metastasis-free survival (SMFS) in NPC.

Methods: A total of 2685 patients with NPC who received bone scintigraphy (BS) and/or 18F-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 2496 patients without skeletal metastasis were retrospectively assessed to develop individual nomograms for SMAD and SMFS. The models were validated externally using separate cohorts of 1329 and 1231 patients treated at two other institutions.

Results: Five independent prognostic factors were included in each nomogram. The SMAD nomogram had a significantly higher c-index than the TNM staging system (training cohort, P = 0.005; validation cohort, P < 0.001). The SMFS nomogram had significantly higher c-index values in the training and validation sets than the TNM staging system (P < 0.001 and P = 0.005, respectively). Three proposed risk stratification groups were created using the nomograms, and enabled significant discrimination of SMFS for each risk group.

Conclusion: The prognostic nomograms established in this study enable accurate stratification of distinct risk groups for skeletal metastasis, which may improve counseling and facilitate individualized management of patients with NPC.

Keywords: Nasopharyngeal carcinoma; Nomograms; Prognosis; Skeletal metastasis at the time of diagnosis (SMAD); Skeletal metastasis free survival (SMFS).

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from the institution through the respective institutional review boards, which belong to the Ethics Committee of Sun Yat-sen University Cancer Center. All patients provided written informed consent to participate in this study.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Nomograms for predicting SMAD (a) and SMFS (b) in NPC. Points refers to the value of each factor included in the nomogram; total points, total points for all factors; 1/3/5-year survival, survival probability based on total points; ALP, alkaline phosphatase; HGB, hemoglobin; LDH, lactate dehydrogenase; CRP, C-reactive protein; EBV, Epstein-Barr virus; SMAD, skeletal metastasis at diagnosis; SMFS, skeletal-metastasis free survival
Fig. 2
Fig. 2
Calibration plots for SMFS at 1, 3 and 5 years in the training cohort (a, b, c) and validation cohort (d, e, f). Nomogram-predicted SMFS is plotted on the x-axis; actual rates of SMFS are plotted on the y-axis. The dashed lines along the 45-degree line through the origin represent the perfect calibration models in which the predicted probabilities are identical to the actual probabilities. SMFS, skeletal-metastasis free survival
Fig. 3
Fig. 3
Kaplan–Meier curves of SMFS for the three risk group stratifications. Nomogram risk group stratifications for the 33 and 66 percentiles are shown for the training cohort (a, c) and validation cohort (b, d). SMFS, skeletal-metastasis free survival
See this image and copyright information in PMC

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