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. 2018 Oct;50(4):1084-1095.
doi: 10.4143/crt.2017.359. Epub 2017 Nov 15.

Proposal of a Pretreatment Nomogram for Predicting Local Recurrence after Intensity-Modulated Radiation Therapy in T4 Nasopharyngeal Carcinoma: A Retrospective Review of 415 Chinese Patients

Lu-Lu Zhang  1 , Yi-Yang Li  2 , Jiang Hu  1 , Guan-Qun Zhou  1 , Lei Chen  1 , Wen-Fei Li  1 , Ai-Hua Lin  3 , Jun Ma  1 , Zhen-Yu Qi  1 , Ying Sun  1
Affiliations

Proposal of a Pretreatment Nomogram for Predicting Local Recurrence after Intensity-Modulated Radiation Therapy in T4 Nasopharyngeal Carcinoma: A Retrospective Review of 415 Chinese Patients

Lu-Lu Zhang et al. Cancer Res Treat. 2018 Oct.

Abstract

Purpose: Local relapse-free survival (LRFS) differs widely among patients with T4 category nasopharyngeal carcinoma (NPC). We aimed to build a nomogram incorporating clinicopathological information to predict LRFS in T4 NPC after definitive intensity-modulated radiation therapy (IMRT).

Materials and methods: Retrospective study of 415 Chinese patients with non-metastatic T4 NPC treated with definitive IMRT with or without chemotherapy at our cancer center between October 2009 and September 2013. The nomogram for LRFS at 3 and 5 years was generated based on multivariate Cox proportional hazards regression, and validated using bootstrap resampling, assessing discriminative performance using the concordance index (C-index) and determining calibration ability via calibration curves.

Results: Five-year LRFS was 88.8%. We identified and incorporated four independent prognostic factors for LRFS: ethmoid sinus invasion, primary gross tumor volume, age, and pretreatment body mass index. The C-index of the nomogram for local recurrence was 0.732 (95% confidence interval, 0.726 to 0.738), indicating excellent predictive accuracy. The calibration curve revealed excellent agreement between nomogram-predicted and observed LRFS probabilities. Risk subgroups based on total point score cutoff values enabled effective discrimination of LRFS.

Conclusion: This pretreatment nomogram enables clinicians to accurately predict LRFS in T4 NPC after definitive IMRT, and could help to facilitate personalized patient counselling and treatment strategies.

Keywords: Intensity-modulated radiation therapy; Nasopharyngeal carcinoma; Nomograms; Recurrence.

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Conflict of interest statement

Conflict of interest relevant to this article was not reported.

Figures

Fig. 1.
Fig. 1.
Nomogram for local recurrence in non-metastatic T4 nasopharyngeal carcinoma after radical intensity-modulated radiation therapy. BMI, body mass index; GTVp, primary gross tumor volume.
Fig. 2.
Fig. 2.
Calibration curves for predicting local recurrence at 3 years (A) and 5 years (B). Nomogram-predicted probability of local recurrence is plotted on the x-axis; actual observed local recurrence-free probability is plotted on the y-axis.
Fig. 3.
Fig. 3.
Kaplan-Meier local recurrence-free survival curves for patients with T4 nasopharyngeal carcinoma based on risk group stratification. Patients were classified into a low-risk group (score < 123), intermediate-risk group (123- 202), and high-risk group (203-325) using total nomogram point score cutoff values determined using X-tile software.
See this image and copyright information in PMC

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