Cancer Res Treat.  2020 Jul;52(3):855-866. 10.4143/crt.2019.772.

Establishment and Validation of a Nomogram for Nasopharyngeal Carcinoma Patients Concerning the Prognostic Effect of Parotid Lymph Node Metastases

• Lin C
• Sun XS
• Liu SL
• Li XY
• Lu N
• Li XL
• Tang LQ
• Guo L

• KMID: 2504465
• DOI: http://doi.org/10.4143/crt.2019.772

Abstract

Purpose
The prognosis of nasopharyngeal carcinoma (NPC) patients with parotid lymph node (PLN) metastasis remains unclear. This study was performed to investigate the prognostic significance and optimal staging category of PLN metastasis and develop a nomogram for estimating individual risk.
Materials and Methods
Clinical data of 7,084 non-metastatic NPC patients were retrospectively reviewed. Overall survival (OS) was the primary endpoint. A nomogram was established based on the Cox proportional hazards regression model. The accuracy and calibration ability of this nomogram was evaluated by C-index and calibration curves with bootstrap validation. Result Totally, 164/7,084 NPC patients (2.3%) presented with PLNs. Multivariate analyses showed that PLN metastasis was a negative prognostic factor for OS, progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS). Patients with PLN metastasis had a worse prognosis than N3 disease. Five independent prognostic factors were included in the nomogram, which showed a C-index of 0.743. The calibration curves for probability of 3- and 5-year OS indicated satisfactory agreement between nomogram-based prediction and actual observation. All results were confirmed in the validation cohort.
Conclusion
NPC patient with PLN metastasis had poorer survival outcome (OS, PFS, DMFS, and LRFS) than N3 disease. We developed a nomogram to provide individual prediction of OS for patients with PLN metastasis.

Keyword

Nasopharyngeal carcinoma; Parotid lymph node metastasis; Nomogram; Radiotherapy; Overall survival

Figure

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  Fig. 1. Flow chart for patient inclusion. NPC, nasopharyngeal carcinoma; SYSUCC, Sun Yat-sen University Cancer Center.

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  Fig. 2. Kaplan-Meier survival curves of overall survival (OS) (A), progression-free survival (PFS) (B), locoregional relapsefree survival (LRFS) (C), and distant metastasis-free survival (DMFS) (D) for comparing 164 patients with parotid lymph nodes (PLN) involvement and 6,920 patients without PLN involvement classified by N classification.

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  Fig. 3. Prognostic nomogram for 3- and 5-year overall survival (OS) based on the training cohort. EBV DNA, Epstein-Barr virus DNA. As an example, locate the patient's sex and draw a line straight up to the “Points” axis to determine the associated score. Add the scores achieved for each covariate, and locate this sum on the “Total Points” axis. Draw a line straight down to determine the likelihood of 3- or 5-year OS. As a calculation parameter, “Linear Predictor” is not directly applied to the calculation of the survival rate.

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  Fig. 4. The calibration plots for predicting overall survival (OS) in training cohort at 3-year (A) and 5-year (B) OS and in validation cohort at 3-year (C) and 5-year (D) OS. Actual OS is plotted on the y-axis; nomogram-predicted probability of OS is plotted on the x-axis.

Reference

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