title: Prognostic Nomogram for Patients with Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy.
abstract: This study was aimed to define possible predictors of overall survival in nasopharyngeal carcinoma (NPC). Patients were treated with intensity-modulated radiation therapy (IMRT), to establish an effective prognostic nomogram that could provide individualized predictions of treatment outcome in this setting. We reviewed the records of 533 patients with non-metastatic NPC who underwent IMRT with or without concurrent chemotherapy at the Department of Radiation Oncology of Sun Yat-Sen University from 2002 to 2009; none of these patients received induction or adjuvant chemotherapy. These data sets were used to construct a nomogram based on Cox regression. Nomogram performance was determined via a concordance index (C-index) and a calibration curve which was compared with the TNM staging system for NPC. The results were validated in an external cohort of 442 patients from the Department of Radiation Oncology of Wenzhou Medical College who were treated during the same period. Results showed that the greatest influence on survival were primary gross tumor volume, age, tumor stage and nodal stage (2002 Union for International Cancer Control [UICC] staging system), which were selected into the nomogram. The C-index of the nomogram for predicting survival was 0.748 (95%CI, 0.704-0.785), which was statistically higher than that of TNM staging system (0.684, P<0.001). The calibration curve exhibited agreement between nomogram-predicted and the actual observed probabilities for overall survival. In the validation cohort, the nomogram discrimination was superior to the TNM staging system (C-index: 0.768 vs 0.721; P = 0.026). In conclusion, the nomogram proposed in this study resulted in more-accurate prognostic prediction for patients with NPC after IMRT and compared favorably to the TNM staging system; this individualized information will aid in patient counseling and may be used for de-escalation trials in the future.
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, P. R. China; Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, P. R. China; Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, P. R. China.
authors.forename: Shixiu
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, P. R. China.
authors.forename: Bing
authors.initials: B
authors.lastname: Xia
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China; Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China.
authors.forename: Fei
authors.initials: F
authors.lastname: Han
authors.affiliation: Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, P. R. China.
authors.forename: Ruifei
authors.initials: R
authors.lastname: Xie
authors.affiliation: Department of Radiation Oncology, Wenzhou Medical College Cancer Center, Wenzhou, Zhejiang, P. R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Song
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China; Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Radiation Oncology, Wenzhou Medical College Cancer Center, Wenzhou, Zhejiang, P. R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China; Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China.
authors.forename: Xiaowu
authors.initials: X
authors.lastname: Deng
authors.affiliation: Department of Radiation Oncology, Wenzhou Medical College Cancer Center, Wenzhou, Zhejiang, P. R. China.
authors.forename: Qiancheng
authors.initials: Q
authors.lastname: He
authors.affiliation: State Key Laboratory of Oncology in Southern China, Guangzhou, P. R. China; Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P. R. China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, P. R. China.
authors.forename: Cong
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, P. R. China; Hubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, P. R. China.
authors.forename: Conghua
authors.initials: C
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D049451:Nomograms; D016016:Proportional Hazards Models; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult