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Nasopharyngeal necrosis contributes to overall survival in nasopharyngeal carcinoma without distant metastasis: a comprehensive nomogram model

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Abstract

Objectives

This study focused on developing and validating a nomogram to predict the overall survival (OS) of patients with nasopharyngeal carcinoma (NPC) without distant metastasis based on their clinical characteristics, serum biomarkers, and presence of nasopharyngeal (NP) necrosis.

Methods

This study included 9298 patients with NPC. Patients from January 2009 to December 2014 were randomly categorized into the training cohort and validation cohort A. Validation cohort B, whose data were collected from January 2015 to December 2017, was also included. OS was the primary endpoint of this study. Cox regression analysis was used to detect independent risk variables. Decision curve analysis, calibration curve, time-dependent receiver operating characteristic (ROC) curve, and concordance index (C-index) were used to evaluate the performance of the nomogram model.

Results

A total of 267 patients developed NP necrosis after the first routine radiotherapy. After radiotherapy, patients with NP necrosis had significantly lower OS than other patients in all three cohorts (p < 0.001). Eleven factors, including NP necrosis, were involved in the nomogram, which had favorable discrimination and calibration with a C-index of 0.768 in the training cohort, 0.749 in validation cohort A, and 0.739 in validation cohort B. The nomogram exhibited a significantly larger area under the ROC curve for predicting OS than the TNM stage and Epstein-Barr virus (EBV) DNA (p < 0.001).

Conclusion

Compared with the TNM system and EBV DNA, we established a nomogram model with an accurate prognostic prediction for patients with NPC, which might help with patient management in NPC.

Key Points

• This study included 9298 patients with NPC, and 11 factors were involved in the final model.

• The nomogram had a significantly higher C-index and area under the ROC curve than the TNM stage and EBV DNA.

• We established the first nomogram model for NPC involving the occurrence of NP necrosis, which was valuable for providing individual counseling and clinical assessments.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

AC:

Adjuvant chemotherapy

AJCC/UICC:

American Joint Committee on Cancer/International Union Against Cancer

C-index:

Concordance index

CI:

Confidence interval

CRP:

C-reactive protein

CT:

Computed tomography

EBV:

Epstein-Barr virus

HGB:

Hemoglobin

IC:

Induction chemotherapy

IMRT:

Intensity-modulated radiation therapy

LDH:

Lactate dehydrogenase

MRI:

Magnetic resonance imaging

NP:

Nasopharyngeal

NPC:

Nasopharyngeal carcinoma

OS:

Overall survival

PET-CT:

Positron emission tomography-computed tomography

qPCR:

Quantitative polymerase chain reaction

ROC:

Receiver operating characteristic

RT:

Radiotherapy

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Acknowledgements

We thank all of the patients who participated in this study.

Funding

This study was funded by grants from the National Key R&D Program of China (2017YFC0908500, 2017YFC1309003), the National Natural Science Foundation of China (No. 81425018, No. 81672868, No. 81802775, No. 82073003, No. 82002852, No. 82003267), the Sci-Tech Project Foundation of Guangzhou City (201707020039), the Sun Yat-sen University Clinical Research 5010 Program (No. 2019023), the Special Support Plan of Guangdong Province (No. 2014TX01R145), the Natural Science Foundation of Guangdong Province (No. 2017A030312003, No. 2018A0303131004), the Natural Science Foundation of Guangdong Province for Distinguished Young Scholar (No. 2018B030306001), the Sci-Tech Project Foundation of Guangdong Province (No. 2014A020212103), the Health & Medical Collaborative Innovation Project of Guangzhou City (No. 201400000001, No. 201803040003), Pearl River S&T Nova Program of Guangzhou (No. 201806010135), the Planned Science and Technology Project of Guangdong Province (2019B020230002), the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No. 2014BAI09B10), Natural Science Foundation of Guangdong Province (2017A030312003),and the Fundamental Research Funds for the Central Universities.

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Author notes

  1. Xue-Song Sun, Zhi-Wen Xiao, and Sai-Lan Liu contributed equally to this work.

Authors and Affiliations

  1. Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xue-Song Sun, Sai-Lan Liu, Rui Sun, Dong-Hua Luo, Qiu-Yan Chen & Hai-Qiang Mai

  2. State Key Laboratory of Oncology in South China, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xue-Song Sun, Sai-Lan Liu, Rui Sun, Dong-Hua Luo, Qiu-Yan Chen & Hai-Qiang Mai

  3. Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xue-Song Sun, Sai-Lan Liu, Rui Sun, Dong-Hua Luo, Qiu-Yan Chen & Hai-Qiang Mai

  4. Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xue-Song Sun, Sai-Lan Liu, Rui Sun, Dong-Hua Luo, Qiu-Yan Chen & Hai-Qiang Mai

  5. Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xue-Song Sun, Sai-Lan Liu, Rui Sun, Dong-Hua Luo, Qiu-Yan Chen & Hai-Qiang Mai

  6. Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Zhi-Wen Xiao

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Corresponding authors

Correspondence to Qiu-Yan Chen or Hai-Qiang Mai.

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Guarantor

The scientific guarantor of this publication is Hai-Qiang Mai.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Xue-Song Sun and Sai-Lan Liu kindly provided statistical advice for this manuscript. No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

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• retrospective

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• performed at one institution

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Sun, XS., Xiao, ZW., Liu, SL. et al. Nasopharyngeal necrosis contributes to overall survival in nasopharyngeal carcinoma without distant metastasis: a comprehensive nomogram model. Eur Radiol 33, 3682–3692 (2023). https://doi.org/10.1007/s00330-023-09431-4

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  • DOI: https://doi.org/10.1007/s00330-023-09431-4

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