title: A prognostic model predicts the risk of distant metastasis and death for patients with nasopharyngeal carcinoma based on pre-treatment serum C-reactive protein and N-classification.
abstract: OBJECTIVE
  Chronic inflammation plays an important role in nasopharyngeal carcinoma (NPC) development and progression. Aim of this study is to determine whether inflammation-related parameters predict distant metastasis in NPC patients.
  
  
  METHODS
  335 newly diagnosed non-metastatic NPC patients were recruited. The values of the C-reactive protein (CRP), lactate dehydrogenase, albumin, globulin, white blood cell and neutrophil at baseline were measured.
  
  
  RESULTS
  Among the above six parameters, only CRP was independently associated with distant metastasis-free survival (DMFS). CRP concentration of advanced T-/TNM-classification patients was higher than those with early classification (P = 0.001). Higher-CRP (CRP ⩾ 2.46 mg/L) predicted shorter overall survival, disease-free survival and DMFS than lower-CRP (CRP < 2.46 mg/L). In a multivariable model, higher-CRP and advanced N-classification were independent predictors of distant metastasis. On the basis of these two parameters, a prognostic NC-model was developed as following: (1) low-risk (early N-classification and lower-CRP); (2) intermediate-risk (advanced N-classification or higher-CRP) and (3) the high-risk distant metastasis (advanced N-classification and higher-CRP). When compared with the low-risk group, the hazard ratios (HRs) for distant metastasis and death for the intermediate-/high-risk patients were 3.6/16.1 and 2.26/7.61, respectively (both P < 0.001).
  
  
  CONCLUSIONS
  We developed a new prognostic model based on CRP and N-classification for predicting distant metastasis and death of NPC patients, which may facilitate patient counselling and individualised treatment.
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Wei-Xiong
authors.initials: WX
authors.lastname: Xia
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Zhang
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Jun-Li
authors.initials: JL
authors.lastname: Shi
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Xing
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Yan-Fang
authors.initials: YF
authors.lastname: Ye
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Ka-Jia
authors.initials: KJ
authors.lastname: Cao
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China.
authors.forename: Chao-Nan
authors.initials: CN
authors.lastname: Qian
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China. Electronic address: guoxiang@sysucc.org.cn.
authors.forename: Xiang
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou 510060, PR China; State Key Laboratory of Oncology in Southern China, Guangzhou 510060, PR China. Electronic address: xiangyq@sysucc.org.cn.
authors.forename: Yan-Qun
authors.initials: YQ
authors.lastname: Xiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism*; D002277:Carcinoma; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D007962:Leukocytes / Q000502:physiology; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality*; D009362:Neoplasm Metastasis; D009504:Neutrophils / Q000502:physiology; D011379:Prognosis; D012372:ROC Curve; D012709:Serum Albumin / Q000378:metabolism; D012712:Serum Globulins / Q000378:metabolism; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D012709:Serum Albumin; D012712:Serum Globulins; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase