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Nomogram for the prediction of primary distant metastasis of nasopharyngeal carcinoma to guide individualized application of FDG PET/CT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to establish an effective nomogram to predict primary distant metastasis (DM) in patients with nasopharyngeal carcinoma (NPC) to guide the application of PET/CT.

Methods

In total, 3591 patients with pathologically confirmed NPC were consecutively enrolled. The nomogram was constructed based on 1922 patients treated between 2007 and 2014. Multivariate logistical regression was applied to identify the independent risk factors of DM. The predictive value of the nomogram was evaluated using the concordance index (C-index), calibration curve, probability density functions (PDFs), and clinical utility curve (CUC). The results were validated in 1669 patients enrolled from 2015 to 2016. Net reclassification improvement (NRI) was applied to compare performances of the nomogram with other clinical factors. The best cut-off value of the nomogram chosen for clinical application was analyzed.

Results

A total of 355 patients showed primary DM among 3591 patients, yielding an incidence rate of 9.9%. Sex, N stage, EBV DNA level, lactate dehydrogenase level, and hemoglobin level were independent predictive factors for primary DM. C-indices in the training and validation cohort were 0.796 (95% CI, 0.76–0.83) and 0.779 (95% CI, 0.74–0.81), respectively. The NRI indices demonstrated that this model had better predictive performance than plasma EBV DNA level and N stage. We advocate for a threshold probability of 3.5% for guiding the application of PET/CT depending on the clinical utility analyses.

Conclusion

This nomogram is a useful tool to predict primary DM of NPC and guide the clinical application of PET/CT individually at the initial staging.

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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. 82073003, No. 81425018, No. 81672868, No.81802775), the Sci-Tech Project Foundation of Guangzhou City (201707020039), the Sun Yat-sen University Clinical Research 5010 Program, 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.

Author information

Author notes

  1. Bei-Bei Xiao, Da-Feng Lin, Xue-Song Sun, Xu Zhang, and Qiu-Yan Chen contributed equally to this work.

    Wei Fan, Hai-Qiang Mai, and Lin-Quan Tang are senior authors and contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Bei-Bei Xiao, Da-Feng Lin, Xue-Song Sun, Xu Zhang, Shan-Shan Guo, Li-Ting Liu, Dong-hua Luo, Rui Sun, Yue-Feng Wen, Ji-Bin Li, Xiao-Fei Lv, Lu-Jun Han, Li Yuan, Sai-Lan Liu, Qing-Nan Tang, Yu-Jing Liang, Xiao-Yun Li, Ling Guo, Qiu-Yan Chen, Wei Fan, Hai-Qiang Mai & Lin-Quan Tang

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

    Bei-Bei Xiao, Da-Feng Lin, Xue-Song Sun, Shan-Shan Guo, Li-Ting Liu, Dong-hua Luo, Rui Sun, Yue-Feng Wen, Sai-Lan Liu, Qing-Nan Tang, Yu-Jing Liang, Xiao-Yun Li, Ling Guo, Qiu-Yan Chen, Hai-Qiang Mai & Lin-Quan Tang

  3. Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xu Zhang & Wei Fan

  4. Department of Clinical Research, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Ji-Bin Li

  5. Department of Medical Imaging, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China

    Xiao-Fei Lv & Lu-Jun Han

Authors
  1. Bei-Bei Xiao
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  2. Da-Feng Lin
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  3. Xue-Song Sun
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  4. Xu Zhang
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  7. Dong-hua Luo
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  8. Rui Sun
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  12. Lu-Jun Han
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  13. Li Yuan
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  14. Sai-Lan Liu
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  15. Qing-Nan Tang
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  18. Ling Guo
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  19. Qiu-Yan Chen
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  20. Wei Fan
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  21. Hai-Qiang Mai
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  22. Lin-Quan Tang
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Corresponding authors

Correspondence to Hai-Qiang Mai or Lin-Quan Tang.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Oncology - Head and Neck

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Xiao, BB., Lin, DF., Sun, XS. et al. Nomogram for the prediction of primary distant metastasis of nasopharyngeal carcinoma to guide individualized application of FDG PET/CT. Eur J Nucl Med Mol Imaging 48, 2586–2598 (2021). https://doi.org/10.1007/s00259-020-05128-8

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  • DOI: https://doi.org/10.1007/s00259-020-05128-8

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