Development and external validation of nomograms predictive of response to radiation therapy and overall survival in nasopharyngeal cancer patients.
BACKGROUND
Large variability in the clinical outcomes has been observed among the nasopharyngeal cancer (NPC) patients with the same stage receiving similar treatment. This suggests that the current Tumour-Node-Metastasis staging systems need to be refined. The nomogram is a useful predictive tool that integrates individual variables into a statistical model to predict outcome of interest. This study was to design predictive nomograms based on the clinical and pathological features of patients with NPC.


METHODS
Clinical data of 270 NPC patients who underwent definitive radiation therapy (RT) alone or concurrent with chemotherapy were collected. Factors predictive of response to RT and overall survival (OS) were determined by univariate and multivariate analyses, and predictive nomograms were created. Nomograms were validated externally by assessing discrimination and calibration using an independent data set (N=122).


RESULTS
Three variables predictive of response to RT (age, histology classification and N classification) and four predictive of OS (age, performance status, smoking status and N classification), in addition to T classification, were extracted to generate the nomograms. The nomograms were validated externally, which showed perfect correlation with each other.


CONCLUSIONS
The designed nomograms proved highly predictive of response to RT and OS in individual patients, and could facilitate individualised and personalised patients' counselling and care.
Department of Otorhinolaryngology-Head and Neck Surgery and Research institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Busan, Republic of Korea.
Jae-Keun
JK
Cho
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Gil-Joon
GJ
Lee
Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Republic of Korea.
Keun-Ik
KI
Yi
Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Republic of Korea.
Kyu-Sup
KS
Cho
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Nayeon
N
Choi
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Jong Se
JS
Kim
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Hakyoung
H
Kim
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Dongryul
D
Oh
Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
Sun-Kyu
SK
Choi
Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
Sin-Ho
SH
Jung
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Han-Sin
HS
Jeong
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: ahnyc@skku.edu.
Yong Chan
YC
Ahn
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D049451:Nomograms; D011379:Prognosis; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
Nasopharyngeal cancer; Nomogram; Outcomes; Prognosis; Validation