A prognostic model combining CD4/CD8 ratio and N stage predicts the risk of distant metastasis for patients with nasopharyngeal carcinoma treated by intensity modulated radiotherapy.
This study aimed to evaluate the correlation between circulating lymphocyte subsets and clinical variables, and design an effective prognostic model for distant metastasis-free survival (DMFS) in NPC. In this study, subsets of circulating lymphocytes were determined in 719 non-metastatic NPC patients before treatment. Overall survival and DMFS was monitored. Significant prognostic factors were identified using univariate and multivariate analyses. Results showed that the percentage of CD19+ lymphocytes correlated negatively with TNM stage (r = -0.082, P = 0.028). Patients with higher CD4/CD8 ratios (≥ 1.77) showed better 5-year DMFS than patients with lower ratios (91.9% vs. 85.4%, P < 0.001). Multivariate analysis revealed that CD4/CD8 ratio (HR, 0.450; 95% confidence interval [CI], 0.266-0.760; P = 0.003) and N classification (HR, 2.294; 95% CI, 1.370-3.839; P = 0.002) were independently prognostic factors for DMFS. The prognostic N-R model was developed and divided patients into three groups: (1) low-risk (early N stage and CD4/CD8 ratio ≥ 1.77); (2) intermediate-risk (advanced N stage or CD4/CD8 ratio < 1.77) and (3) high-risk (advanced N stage and CD4/CD8 ratio < 1.77) of distant metastasis. In conclusion our prognostic model, based on clinical N stage and CD4/CD8 ratio, may predict the risk of distant metastasis, allowing individualized treatment for NPC.
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Chang-Juan
CJ
Tao
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Yuan-Yuan
YY
Chen
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Feng
F
Jiang
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Xing-Lai
XL
Feng
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Qi-Feng
QF
Jin
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Ting
T
Jin
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Yong-Feng
YF
Piao
Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China.
Xiao-Zhong
XZ
Chen
D000328:Adult; D000368:Aged; D016516:CD4-CD8 Ratio; D002277:Carcinoma / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012306:Risk
CD4/CD8 ratio; distant metastasis; lymphocyte subset; nasopharyngeal carcinoma; survival