title: A nomogram for predicting survival of nasopharyngeal carcinoma patients with metachronous metastasis.
abstract: Patients with metachronous metastatic nasopharyngeal carcinoma (NPC) differ significantly in survival outcomes. The aim of this study is to build a clinically practical nomogram incorporating known tumor prognostic factors to predict survival for metastatic NPC patients in epidemic areas.A total of 860 patients with metachronous metastatic nasopharyngeal carcinoma were analyzed retrospectively. Variables assessed were age, gender, body mass index, Karnofsky Performance Status (KPS), Union for International Cancer Control (UICC) T and N stages, World Health Organization (WHO) histology type, serum lactate dehydrogenase (sLDH) level, serum Epstein-Barr virus (EBV) level, treatment modality, specific metastatic location (lung/liver/bone), number of metastatic location(s) (isolated vs multiple), and number of metastatic lesion(s) in metastatic location(s) (single vs multiple). The independent prognostic factors for overall survival (OS) by Cox-regression model were utilized to build the nomogram.Independent prognostic factors for OS of metastatic NPC patients included age, UICC N stage, KPS, sLDH, number of metastatic locations, number of metastatic lesions, involvement of liver metastasis, and involvement of bone metastasis. Calibration of the final model suggested a c-index of 0.68 (95% confidence interval [CI], 0.65-0.69). Based on the total point (TP) by nomogram, we further subdivided the study cohort into 4 groups. Group 1 (TP < 320, 208 patients) had the lowest risk of dying. Discrimination was visualized by the differences in survival between these 4 groups (group 2/group 1: hazard ratio [HR] = 1.61, 95%CI: 1.24-2.09; group 3/group 1: HR = 2.20, 95%CI: 1.69-2.86; and group 4/group 1: HR = 3.66, 95%CI: 2.82-4.75).The developed nomogram can help guide the prognostication of patients with metachronous metastatic NPC in epidemic areas.
authors.affiliation: Zhong Shan Medical School, Sun Yat-sen University Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou Department of Medical Oncology, Sichuan Cancer Hospital and Institute, Chengdu, People's Republic of China.
authors.forename: Zixun
authors.initials: Z
authors.lastname: Zeng
authors.forename: Lujun
authors.initials: L
authors.lastname: Shen
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: Feng
authors.initials: F
authors.lastname: Shi
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.forename: Ming
authors.initials: M
authors.lastname: Wu
authors.forename: Yutong
authors.initials: Y
authors.lastname: Bai
authors.forename: Changchuan
authors.initials: C
authors.lastname: Pan
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Xia
authors.forename: Peihong
authors.initials: P
authors.lastname: Wu
authors.forename: Wang
authors.initials: W
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary*; D002277:Carcinoma; D002648:Child; D002681:China / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary*; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D009367:Neoplasm Staging; D049451:Nomograms; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis