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. 2024 Oct 14:16:17588359241286489.
doi: 10.1177/17588359241286489. eCollection 2024.

Prognostic value of immune-inflammatory and nutrition indicators in non-metastatic nasopharyngeal carcinoma with negative plasma Epstein-Barr virus DNA

Youliang Weng  1 , Lishui Wu  1 , Ying Li  1 , Jing Wang  1 , Zijie Wu  1 , Xinyi Hong  1 , Xiaoyong Liu  1 , Jinghua Lai  1 , Jun Lu  2 , Sufang Qiu  3   4   5
Affiliations

Prognostic value of immune-inflammatory and nutrition indicators in non-metastatic nasopharyngeal carcinoma with negative plasma Epstein-Barr virus DNA

Youliang Weng et al. Ther Adv Med Oncol. .

Abstract

Background: Plasma Epstein-Barr virus (EBV) DNA has been identified as a significant prognostic marker for nasopharyngeal carcinoma (NPC), yet there is limited research on the prognosis of NPC patients with negative EBV DNA.

Objectives: We explore the prognostic value of comprehensive immune-inflammatory and nutritional indicators to offer personalized treatment recommendations and prognosis predictions for non-metastatic NPC patients with negative EBV DNA.

Design: This was a retrospective study.

Methods: This study retrospectively analyzed 257 non-metastatic NPC patients with negative EBV DNA between January 2015 and December 2019. The Kaplan-Meier survival curves evaluated survival endpoints, and group discrepancies were assessed with log-rank tests. Principal component analysis (PCA) reduced data dimensionality. Univariate and multivariate Cox regression analyses identified significant prognostic variables. Risk stratification was performed based on recursive partitioning analysis (RPA). A robust prognostic model was constructed by nomogram and evaluated by calibration curves, decision curves, and the time-dependent area under the curve analysis.

Results: PCA was employed to compute the immune-inflammation index (III) and nutrition index (NI). Multivariate Cox regression analysis revealed lactate dehydrogenase, III, and NI as significant prognostic variables for overall survival (OS). Utilizing RPA, we stratified the risk into three categories: low-risk group (low III + high NI), middle-risk group (low III + low NI), and high-risk group (high III). Both the middle- (p = 0.025) and high-risk groups (p < 0.001) exhibited poorer OS compared with the low-risk group. The nomogram model exhibited superior predictive accuracy compared to tumor lymph node metastasis stage alone (C-index: 0.774 vs 0.679).

Conclusion: Our study validated the prognostic significance of III and NI in non-metastatic NPC patients with negative EBV DNA. Additionally, a clinical risk stratification was constructed to offer valuable insights into the individualized treatment of these patients.

Keywords: immune-inflammation index; nasopharyngeal carcinoma; negative EBV DNA; nutrition index; prognostic factor.

Plain language summary

Biomarkers of inflammation and nutrition can effectively predict the prognosis of EBV DNA-negative non-metastatic nasopharyngeal carcinoma Why was the study done? Plasma Epstein-Barr virus (EBV) DNA has shown efficacy in predicting survival and disease progression in individuals with nasopharyngeal carcinoma (NPC). However, a subset of patients exhibit negative EBV DNA levels. Currently, there is limited research available on the prognostic implications for this particular patient population. What did the researchers do? The researchers gathered clinical data from Fujian Cancer Hospital between 2015 and 2019 in order to investigate the potential of immune-inflammatory and nutritional markers in predicting both survival rates and disease progression among patients diagnosed with EBV DNA-negative, non-metastatic NPC. Additionally, the study aimed to assess the feasibility of utilizing these markers to offer personalized treatment recommendations for this specific patient population. What did the researchers find? A total of 257 non-metastatic NPC patients with negative EBV DNA were included in the study for clinical data collection. The findings suggest that a lower immune-inflammation index and a higher nutrition index were correlated with extended overall survival (OS) in this patient population. Furthermore, the study indicates that the survival advantage of abstaining from induction chemotherapy (IC) may be more pronounced in this particular cohort. What do the findings mean? This study has identified immune-inflammatory and nutritional markers as predictive of survival in NPC patients with EBV DNA-negative and raised thinking about reducing treatment intensity and improving the quality of life in this population patients in the future.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
The Kaplan–Meier survival curve of overall survival (a), local–regional recurrence-free survival (b), distant metastasis-free survival (c), progression-free survival (d).
Figure 2.
Figure 2.
PCA load plot that visualized the relationship between variables and principal components and the contribution value of each principal component. ALB, albumin; MLR, monocyte-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PCA, principal component analysis; PIV, pan-immune-inflammation value; PLR, platelet-to lymphocyte ratio; PNI, prognostic nutritional index; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index.
Figure 3.
Figure 3.
Univariate COX regression analysis of OS for non-metastatic NPC patients with negative EBV DNA. CCRT, concurrent chemoradiotherapy; CI, confidence interval; EBV, Epstein–Barr virus; HR, hazard ratio; IC, induction chemotherapy; III, immune-inflammation index; LDH, lactate dehydrogenase; NI, nutrition index; NPC, nasopharyngeal carcinoma; OS, overall survival.
Figure 4.
Figure 4.
Multivariate COX regression analysis of OS for non-metastatic NPC patients with negative EBV DNA. CCRT, concurrent chemoradiotherapy; CI, confidence interval; EBV, Epstein–Barr virus; HR, hazard ratio; IC, induction chemotherapy; III, immune-inflammation index; LDH, lactate dehydrogenase; NI, nutrition index; NPC, nasopharyngeal carcinoma; OS, overall survival.
Figure 5.
Figure 5.
Construction of RPA prognostic risk stratification in non-metastatic NPC patients with negative EBV DNA for overall survival (a). The Kaplan–Meier survival curve of overall survival for the comparison of different risk groups (b). EBV, Epstein–Barr virus; III, immune-inflammation index; NI, nutrition index; NPC, nasopharyngeal carcinoma; RPA, recursive partitioning analysis.
Figure 6.
Figure 6.
Development and evaluation of nomogram model for OS. Nomogram score model (a); the 1-, 3-, and 5-year calibration curves (b); the decision curve (c); the time AUC curves (d). AUC, area under the curve; IC, induction chemotherapy; III, immune-inflammation index; LDH, lactate dehydrogenase; NI, nutrition index; OS, overall survival; RPA, recursive partitioning analysis.
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