Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Extraction and Patient Selection
2.2. Examinations and Treatment Protocols
2.3. Follow-Up and Endpoints
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics and Follow-Up
3.2. Development and Validation of Nomograms for DFS
3.3. Risk Stratification Based on the Nomogram
3.4. Risk-Adapted Treatment Strategies Based on the Nomogram and CCI
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Entire Cohort No. (%) | p-Value | HR (95% CI) |
---|---|---|---|
Age, years | |||
≤68 | 336 (57.6%) | Ref. | |
>68 | 247 (42.4%) | 0.076 | 1.26 (0.97–1.63) |
Gender | |||
Male | 463 (79.4) | Ref. | |
Female | 120 (20.6) | 0.373 | 0.86 (0.61–1.20) |
Histological type (WHO) 1 | |||
Type I–II | 18 (3.1) | Ref. | |
Type III | 565 (96.9) | 0.749 | 1.14 (0.51–2.57) |
Smoking | |||
Yes | 232 (39.8) | Ref. | |
No | 351 (60.2) | 0.992 | 1.00 (0.77–1.30) |
Drinking | |||
Yes | 92 (15.8) | Ref. | |
No | 491 (84.2) | 0.970 | 0.99 (0.70–1.42) |
Family history of NPC | |||
Yes | 115 (19.7) | Ref. | |
No | 468 (80.3) | 0.321 | 0.84 (0.60–1.18) |
EBV DNA, copies/mL 2 | |||
<4000 | 320 (54.9) | Ref. | |
≥4000 | 263 (45.1) | < 0.001 | 2.65 (2.03–3.47) |
LDH, IU/L 2 | |||
≤250 | 540 (92.6) | Ref. | |
>250 | 43 (7.4) | 0.243 | 1.32 (0.83–2.12) |
HGB, g/L 2 | |||
≤120 | 51 (8.7) | Ref. | |
>120 | 532 (91.3) | 0.024 | 0.63 (0.42–0.94) |
CRP, mg/L 2 | |||
≤3 | 349 (59.9) | Ref. | |
>3 | 234 (40.1) | 0.043 | 1.31 (1.01–1.69) |
ALB, g/L 2 | |||
≤40 | 117 (20.1) | Ref. | |
>40 | 466 (79.9) | < 0.001 | 0.59 (0.44–0.78) |
T classification 3 | |||
T4 | 161 (27.5) | Ref. | |
T1 | 19 (3.3) | 0.146 | 0.56 (0.26–1.22) |
T2 | 18 (3.1) | 0.369 | 0.70 (0.32–1.51) |
T3 | 385 (66.0) | < 0.001 | 0.53 (0.41–0.69) |
N classification 3 | |||
N0 | 92 (15.8) | Ref. | |
N1 | 265 (45.5) | 0.362 | 1.22 (0.80–1.87) |
N2 | 138 (23.7) | 0.003 | 1.97 (1.26–3.08) |
N3 | 88 (15.1) | < 0.001 | 2.34 (1.46–3.77) |
Overall stage 3 | |||
III | 358 (61.4) | Ref. | |
IVa | 225 (38.6) | < 0.001 | 1.99 (1.54–2.58) |
Radiotherapy techniques | |||
IMRT | 569 (97.6%) | Ref. | |
2D-RT/3D-CRT | 14 (2.4%) | 0.752 | 0.88 (0.38–1.97) |
CCI 4 | |||
=2 | 252 (43.2) | - | - |
>2 | 331 (56.8) | - | - |
Treatment modality | |||
RT alone | 240 (41.2) | - | - |
CRT | 343 (58.8) | - | - |
Risk Factors | C-Index (95% CI) | p-Value | AUC (95% CI) | p-Value |
---|---|---|---|---|
Prognostic models | ||||
Nomogram | 0.668 (0.633–0.703) | Ref. | 0.710 (0.671–0.746) | Ref. |
8th TNM staging system 1 | 0.585 (0.552–0.618) | <0.001 | 0.607 (0.567–0.647) | <0.001 |
Single risk factors | ||||
EBV DNA | 0.619 (0.587–0.652) | <0.001 | 0.656 (0.617–0.695) | <0.001 |
T classification 1 | 0.561 (0.528–0.595) | <0.001 | 0.588 (0.547–0.628) | <0.001 |
N classification 1 | 0.584 (0.548–0.620) | <0.001 | 0.590 (0.549–0.630) | <0.001 |
ALB | 0.549 (0.520–0.578) | <0.001 | 0.558 (0.517–0.599) | <0.001 |
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Kou, J.; Zhang, L.-L.; Yang, X.-L.; Wen, D.-W.; Zhou, G.-Q.; Wu, C.-F.; Xu, S.-S.; Zheng, W.-H.; Qi, Z.-Y.; Sun, Y.; et al. Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma. J. Pers. Med. 2021, 11, 1065. https://doi.org/10.3390/jpm11111065
Kou J, Zhang L-L, Yang X-L, Wen D-W, Zhou G-Q, Wu C-F, Xu S-S, Zheng W-H, Qi Z-Y, Sun Y, et al. Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma. Journal of Personalized Medicine. 2021; 11(11):1065. https://doi.org/10.3390/jpm11111065
Chicago/Turabian StyleKou, Jia, Lu-Lu Zhang, Xing-Li Yang, Dan-Wan Wen, Guan-Qun Zhou, Chen-Fei Wu, Si-Si Xu, Wei-Hong Zheng, Zhen-Yu Qi, Ying Sun, and et al. 2021. "Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma" Journal of Personalized Medicine 11, no. 11: 1065. https://doi.org/10.3390/jpm11111065