Prognostic score models for survival of nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy and chemotherapy

// Lei Zeng 1,2,3 , Pi Guo 4 , Jin-Gao Li 3 , Fei Han 1,2 , Qiang Li 3 , Yong Lu 4 , Xiao-Wu Deng 1,2 , Qing-Ying Zhang 5 and Tai-Xiang Lu 1,2 1 State Key Laboratory Oncology in South China, Collaborative Innovation Center of Cancer Medicine, PR China 2 Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, PR China 3 Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, PR China 4 Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, PR China 5 Department of Preventive Medicine, Shantou University Medical College, Shantou, PR China Correspondence to: Tai-Xiang Lu, email: // Qing-Ying Zhang, email: // Keywords : nasopharyngeal carcinoma, prognostic score model, intensity-modulated radiotherapy, prognostic factors, nomogram Received : June 22, 2015 Accepted : September 04, 2015 Published : September 22, 2015 Abstract Purpose: To establish accurate prognostic score models to predict survival for patients with nasopharyngeal carcinoma (NPC), treated with intensity-modulated radiotherapy (IMRT) and chemotherapy. Materials and methods: Six hundred and seventy-five patients with newly diagnosed, nonmetastatic and histologically proven NPC who were treated with IMRT and chemotherapy were analyzed retrospectively. Samples were split randomly into a training set ( n = 338) and a test set ( n = 337) to analyze. All data from the training set were used to perform an extensive survival analysis and to develop multivariate nomograms based on Cox regression. Data from the test set was used as an external validation set. Risk group stratification was proposed for the nomograms. Results: The nomograms are able to predict survival with a C-index for external validation of local recurrence-free survival (LRFS; 0.66, 95% CI: 0.58-0.74), distant metastasis-free survival (DMFS; 0.73, 95% CI: 0.66-0.79), and disease-specific survival (DSS; 0.73, 95% CI: 0.67-0.79). The calibration curve for probability of survival showed good agreement between prediction by nomogram and actual observation. The C-index of the nomogram for LRFS, DMFS and DSS were statistically higher than the C-index values of the AJCC seventh edition ( P < 0.001). In the test set, the nomogram discrimination was also superior to the AJCC Staging systems ( P < 0.001). The stratification in risk groups allows significant distinction between Kaplan-Meier curves for outcome. Conclusions: Prognostic score models were successfully established and validated to predict LRFS, DMFS, and DSS over a 5-year period after IMRT and chemotherapy, which will be useful for individual treatment.