title: Proposal of a clinical typing system and generation of a prognostic model in patients with nasopharyngeal carcinoma from Southern China.
abstract: OBJECTIVE
  To propose a novel clinical typing classification focusing on the distinct progression patterns of nasopharyngeal carcinoma (NPC), to supplement our knowledge of the clinical-biological behavior, to provide useful knowledge for treatment planning, and to contribute to basic research in NPC.
  
  
  METHODS
  632 consecutive patients were retrospectively reviewed and analyzed according to the novel typing system. We considered that NPC can be divided into 5 types as follows: limited (L), ascending (A), descending (D) ascending- descending (mixed) (AD), and distant metastasis types (M). The distribution of these clinical types, their association with Epstein-Barr virus (EBV) serology and prognostic value were explored.
  
  
  RESULTS
  55 (8.70%), 59 (9.34%), 177 (28.01%), 321 (50.79%) and 20 (3.16%) patients were classified as Type L, A, D, AD and M, respectively. EBV (VCA)-IgA titers, EBV early antigen (EA)-IgA serum titers, and capsid antigen lg(EBV DNA) were positively associated with the clinical typing (p<0.05). The 3-year overall survival (OS) rates for Types L, A, D, AD and M were 100, 100, 95.10, 88.20 and 59.30%, respectively (p<0.001). A prognostic model was constructed based on pretreatment lg (EBV DNA) and clinical type, which were independent predictors of OS (multivariate Cox proportional model). The prognostic model stratified patients into 4 risk subgroups. The 3-year OS rates of the low, intermediate, high and extremely high risk groups were 99.5, 90.0, 85.5 and 53.2%, respectively (p<0.001). Compared with the low-risk group, the risk of death was 4.96, 8.75 and 35.9 in the intermediate, high and extremely high risk groups, respectively (p<0.001). The model also predicted OS independently of TNM classification.
  
  
  CONCLUSIONS
  This novel clinical typing system and prognostic model can supplement TNM classification, and may help design novel treatment strategies, evaluate risk stratification and investigate the varied biological characteristics of NPC.
authors: State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, P. R. China.
authors: Peng
authors: P
authors: Sun
authors: Cui
authors: C
authors: Chen
authors: Xin-Lin
authors: XL
authors: Chen
authors: Yi-Kan
authors: YK
authors: Cheng
authors: Lei
authors: L
authors: Zeng
authors: Zhi-Jian
authors: ZJ
authors: Zeng
authors: Li-Zhi
authors: LZ
authors: Liu
authors: Yong
authors: Y
authors: Su
authors: Mo-Fa
authors: MF
authors: Gu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D002648:Child; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology / Q000821:virology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D004279:DNA, Viral