title: Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy.
abstract: BACKGROUND
  The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system.
  
  
  METHODS
  Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups.
  
  
  RESULTS
  A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively.
  
  
  CONCLUSIONS
  The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307-3315. © 2016 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.|Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian, China.
authors.forename: Jian Ji
authors.initials: JJ
authors.lastname: Pan
authors.affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Wai Tong
authors.initials: WT
authors.lastname: Ng
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.|Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian, China.
authors.forename: Jing Feng
authors.initials: JF
authors.lastname: Zong
authors.affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Sarah W M
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong, China.
authors.forename: Horace C W
authors.initials: HC
authors.lastname: Choi
authors.affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Lucy L K
authors.initials: LL
authors.lastname: Chan
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.|Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian, China.
authors.forename: Shao Jun
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.|Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian, China.
authors.forename: Qiao Juan
authors.initials: QJ
authors.lastname: Guo
authors.affiliation: Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Henry C K
authors.initials: HC
authors.lastname: Sze
authors.affiliation: Department of Radiology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.
authors.forename: Yun Bin
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Department of Radiology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.
authors.forename: You Ping
authors.initials: YP
authors.lastname: Xiao
authors.affiliation: Department of Diagnostic Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
authors.forename: Wai Kuen
authors.initials: WK
authors.lastname: Kan
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, California.
authors.forename: Quynh Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Department of Clinical Radiology, University of California San Francisco, San Francisco, California.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Glastonbury
authors.affiliation: Department of Medicine (Oncology), Stanford Cancer Institute, Stanford University, Stanford, California.
authors.forename: A Dimitrios
authors.initials: AD
authors.lastname: Colevas
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.affiliation: Department of Otolaryngology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: William
authors.initials: W
authors.lastname: Lydiatt
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.affiliation: Department of Clinical Oncology, University of Hong Kong/University of Hong Kong-Shenzhen Hospital, Hong Kong, China. awmlee@hku.hk.
authors.forename: Anne W M
authors.initials: AW
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy*; D009367:Neoplasm Staging / Q000592:standards*; D049451:Nomograms; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007770:L-Lactate Dehydrogenase
keywords: TNM staging; intensity-modulated radiotherapy; nasopharyngeal carcinoma; nomogram; prognostication