title: Prognostic value of the distance between the primary tumor and brainstem in the patients with locally advanced nasopharyngeal carcinoma.
abstract: BACKGROUND
  Brainstem dose limitations influence radiation dose reaching to tumor in the patients with locally-advanced nasopharyngeal cancer (NPC).
  
  
  METHODS
  A retrospective analysis of the prognostic value of the distance between the primary tumor and brainstem (Dbs) in 358 patients with locally-advanced NPC after intensity-modulated radiation therapy (IMRT). Receiver operating characteristic (ROC) curves were used to identify the cut-off value to analyze the impact of Dbs on tumor dose coverage and prognosis.
  
  
  RESULTS
  The three-year overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were 88.8 vs. 78.4% (P = 0.007), 96.5 vs. 91.1% (P = 0.018), 87.8 vs. 79.3% (P = 0.067), and 84.1 vs. 69.6% (P = 0.002) for the patients with the Dbs > 4.7 vs. ≤ 4.7 mm, respectively. ROC curves revealed Dbs (4.7 mm) combined with American Joint Committee on Cancer (AJCC) T classification had a significantly better prognostic value for OS (P < 0.05).
  
  
  CONCLUSIONS
  Dbs (≤ 4.7 mm) is an independent negative prognostic factor for OS/LRFS/DFS and enhances the prognostic value of T classification in the patients with locally-advanced NPC.
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. heyuxiang88@163.com.
authors.forename: Yuxiang
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. wylionking@163.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. linshen2014@yeah.net.
authors.forename: Lin
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. 2609292737@qq.com.
authors.forename: Yajie
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. caopengfei66@163.com.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Cao
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. 9511985@qq.com.
authors.forename: Mingjun
authors.initials: M
authors.lastname: Lei
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. cdm888@sina.com.
authors.forename: Dengming
authors.initials: D
authors.lastname: Chen
authors.affiliation: School of Public Health, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. 1064960669@qq.com.
authors.forename: Tubao
authors.initials: T
authors.lastname: Yang
authors.affiliation: Department of Oncology, Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. lfshen2008@163.com.
authors.forename: Liangfang
authors.initials: L
authors.lastname: Shen
authors.affiliation: Xiangya Hospital, Central South University, Hunan Province, No. 87, Xiangya Road, Changsha, Hunan Province, 410008, PR China. shousongc@gmail.com.
authors.forename: Shousong
authors.initials: S
authors.lastname: Cao
mesh_terms: D001933:Brain Stem / Q000473:pathology*; D002277:Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology* / Q000532:radiotherapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D012306:Risk