Evaluation of a novel model incorporating serological indicators into the conventional TNM staging system for nasopharyngeal carcinoma

• Published in: Oral oncology Vol. 151; p. 106725
• Main Authors: Ding, Cong, Dai, Dong-Yu, Luo, Zi-Kang, Wang, Gao-Yuan, Dong, Zhe, Qin, Guan-Jie, Du, Xiao-Jing, Ma, Jun
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2024
• Subjects: 8th TNM staging; DNA; Epstein-Barr Virus Infections; Herpesvirus 4, Human - genetics; Humans; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - pathology; Nasopharyngeal Neoplasms - pathology; Neoplasm Staging; Prognosis; Recursive partitioning analysis; Retrospective Studies; Serological indicator; 8th TNM staging; NPC; CRP; RPA; IMRT; NRI; cfEBV DNA; MRI; Serological indicator; SYSUCC; PET-CT; HR; AUC; Nasopharyngeal carcinoma; DFS; LDH; IC; LANPC; DCA; OS; CI; ROC; IQR; PSM; AJCC/UICC; Recursive partitioning analysis; CAR; CCRT; PET
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2024.106725

•Epstein–Barr virus DNA is a key nasopharyngeal carcinoma (NPC) prognosis predictor.•Lactate dehydrogenase is an independent prognostic factor for NPC.•C-reactive protein-to-albumin ratio also predicts NPC prognosis independently.•Incorporating serological indicators may improve the TNM staging system for NPC. Non-anatomical factors significantly affect treatment guidance and prognostic prediction in nasopharyngeal carcinoma (NPC) patients. Here, we developed a novel survival model by combining conventional TNM staging and serological indicators. We retrospectively enrolled 10,914 eligible patients with nonmetastatic NPC over 2009–2017 and randomly divided them into training (n = 7672) and validation (n = 3242) cohorts. The new staging system was constructed based on T category, N category, and pretreatment serological markers by using recursive partitioning analysis (RPA). In multivariate Cox analysis, pretreatment cell-free Epstein–Barr virus (cfEBV) DNA levels of >2000 copies/mL [HROS (95 % CI) = 1.78 (1.57–2.02)], elevated lactate dehydrogenase (LDH) levels [HROS (95 % CI) = 1.64 (1.41–1.92)], and C-reactive protein-to-albumin ratio (CAR) of >0.04 [HROS (95 % CI) = 1.20 (1.07–1.34)] were associated with negative prognosis (all P < 0.05). Through RPA, we stratified patients into four risk groups: RPA I (n = 3209), RPA II (n = 2063), RPA III (n = 1263), and RPA IV (n = 1137), with 5-year overall survival (OS) rates of 93.2 %, 86.0 %, 80.6 %, and 71.9 % (all P < 0.001), respectively. Compared with the TNM staging system (eighth edition), RPA risk grouping demonstrated higher prognostic prediction efficacy in the training [area under the curve (AUC) = 0.661 vs. 0.631, P < 0.001] and validation (AUC = 0.687 vs. 0.654, P = 0.001) cohorts. Furthermore, our model could distinguish sensitive patients suitable for induction chemotherapy well. Our novel RPA staging model outperformed the current TNM staging system in prognostic prediction and clinical decision-making. We recommend incorporating cfEBV DNA, LDH, and CAR into the TNM staging system.