Kuiyuan Liu1, Siting Lin2, Liangru Ke3, Weixiong Xia1, Chun Zhang4, Jianpeng Li5, Mingyong Gao6, Mengyun Qiang1, Xi Chen1, Jia Liu7, Chuanmiao Xie8, Xiang Guo9, Xing Lv10. 1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China. 2. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China. 3. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Radiology, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China. 4. Department of Radiotherapy, Dongguan People's Hospital, Dongguan 523000, People's Republic of China. 5. Department of Radiology, Dongguan People's Hospital, Dongguan 523000, People's Republic of China. 6. Department of Radiology, Foshan No.1 People's Hospital, Foshan 528000, People's Republic of China. 7. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Intensive Care Center, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China. 8. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Radiology, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China. Electronic address: xiechm@sysucc.org. 9. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China. Electronic address: guoxiang@sysucc.org.cn. 10. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China. Electronic address: lvxing@sysucc.org.cn.
Abstract
OBJECTIVE: There were few studies focused on the cervical lymph necrosis (CNN) of nasopharyngeal carcinoma (NPC) patients to develop a nomogram and guide the treatment decision at the era of intensity modulated radiation therapy (IMRT). MATERIAL AND METHODS: The prognostic accuracy of CNN in the training cohort (n = 1940) was validated in Guangzhou internal validation cohort (n = 832) and two external validation cohorts (Dongguan, n = 232; Foshan, n = 134). RESULTS: The primary end point was progression-free survival (PFS), calculated using the Kaplan-Meier method. After a median 60.0 months' follow-up, patients with CNN in the training cohort had worse 5-year PFS (70.8% vs. 89.1%, P < 0.001) than patients without CNN, which was validated in the validation cohorts. The nomogram based on CNN predicted an individual PFS risk (training: C-index 0.733; Guangzhou validation: C-index 0.736; Foshan: C-index 0.722; Dongguan: C-index 0.756). Stage N2 patients in the CNN group and stage IV patients no matter the status of CNN, PFS was better with induction chemotherapy (ICT) and CCRT than CCRT (P < 0.05). CONCLUSION: Taken together, CNN reliably predicts survival risk in NPC patients. N2 patients in the CNN group and stage IV patients may receive survival benefit from ICT.
OBJECTIVE: There were few studies focused on the cervical lymph necrosis (CNN) of nasopharyngeal carcinoma (NPC) patients to develop a nomogram and guide the treatment decision at the era of intensity modulated radiation therapy (IMRT). MATERIAL AND METHODS: The prognostic accuracy of CNN in the training cohort (n = 1940) was validated in Guangzhou internal validation cohort (n = 832) and two external validation cohorts (Dongguan, n = 232; Foshan, n = 134). RESULTS: The primary end point was progression-free survival (PFS), calculated using the Kaplan-Meier method. After a median 60.0 months' follow-up, patients with CNN in the training cohort had worse 5-year PFS (70.8% vs. 89.1%, P < 0.001) than patients without CNN, which was validated in the validation cohorts. The nomogram based on CNN predicted an individual PFS risk (training: C-index 0.733; Guangzhou validation: C-index 0.736; Foshan: C-index 0.722; Dongguan: C-index 0.756). Stage N2 patients in the CNN group and stage IV patients no matter the status of CNN, PFS was better with induction chemotherapy (ICT) and CCRT than CCRT (P < 0.05). CONCLUSION: Taken together, CNN reliably predicts survival risk in NPC patients. N2 patients in the CNN group and stage IV patients may receive survival benefit from ICT.
Authors: Qi-Yong H Ai; Kuo Feng Hung; Tiffany Y So; Frankie K F Mo; Wing Tsung Anthony Chin; Edwin P Hui; Brigette B Y Ma; Michael Ying; Ann D King Journal: Cancer Imaging Date: 2022-05-20 Impact factor: 5.605