Academic radiology · 2025
Development and Validation of a Nomogram Based on the Different Grades of Cervical Lymph Node Necrosis to Predict Overall Survival in Patients with Lymph Node-Positive Locally Advanced Nasopharyngeal Carcinoma.
СтатьяВалидационное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wang Run-Zhi, Zhu Li-Ru, Xu Yao-Can, Chen Mei-Wen, Liang Zhong-Guo, Chen Kai-Hua, Li Ling, Zhu Xiao-Dong
Аннотация
RATIONALE AND OBJECTIVES: This study aims to quantitatively evaluate the clinical significance of different grades of cervical lymph node necrosis (CNN). Furthermore, a nomogram was developed and validated to predict overall survival (OS) in patients with lymph node-positive (LN-positive) locally advanced nasopharyngeal carcinoma (LA-NPC), incorporating the different grades of CNN.
PATIENTS AND METHODS: We retrospectively analyzed patients with newly diagnosed, LN-positive LA-NPC at our center from April 2014 to December 2018. Independent predictors were identified through Cox regression analyses, which examined the grade of CNN and other clinical variables associated with OS. Based on the results and a key clinical variable, a nomogram was developed to predict OS. Model performance was evaluated through discrimination, calibration, and clinical utility. Risk stratification was performed using the risk score derived from the nomogram, and the prognoses of two distinct risk groups were compared using the Kaplan-Meier method.
RESULTS: A total of 984 patients were enrolled. Independent predictors for OS, confirmed by multivariate Cox analysis, included age (hazard ratio [HR]: 1.57, 95% CI: 1.09-2.26, P=0.016), Epstein-Barr virus (EBV) DNA (HR: 2.02, 95% CI: 1.40-2.92, P<0.001), N3 (HR: 2.30, 95% CI: 1.42-3.72, P=0.001), Grade of CNN (HR: 1.53, 95% CI: 1.02-2.30, P=0.042), and LDH (HR: 1.48, 95% CI: 1.01-2.15, P=0.043). The nomogram developed by combining these five variables and T stage demonstrated a higher C-index in both the training cohort (0.715 versus 0.624, P<0.001) and validation cohort (0.744 versus 0.629, P<0.001), as well as a higher net clinical benefit compared to the 8th edition TNM staging system (TNM-8).
CONCLUSION: The grade of CNN is a promising adverse predictor for patients with LA-NPC. Compared to the TNM-8, the nomogram incorporating the Grade of CNN demonstrates superior predictive efficacy and enhanced risk stratification.
AVAILABILITY OF DATA AND MATERIAL: The data are available from the corresponding author upon request.
PATIENTS AND METHODS: We retrospectively analyzed patients with newly diagnosed, LN-positive LA-NPC at our center from April 2014 to December 2018. Independent predictors were identified through Cox regression analyses, which examined the grade of CNN and other clinical variables associated with OS. Based on the results and a key clinical variable, a nomogram was developed to predict OS. Model performance was evaluated through discrimination, calibration, and clinical utility. Risk stratification was performed using the risk score derived from the nomogram, and the prognoses of two distinct risk groups were compared using the Kaplan-Meier method.
RESULTS: A total of 984 patients were enrolled. Independent predictors for OS, confirmed by multivariate Cox analysis, included age (hazard ratio [HR]: 1.57, 95% CI: 1.09-2.26, P=0.016), Epstein-Barr virus (EBV) DNA (HR: 2.02, 95% CI: 1.40-2.92, P<0.001), N3 (HR: 2.30, 95% CI: 1.42-3.72, P=0.001), Grade of CNN (HR: 1.53, 95% CI: 1.02-2.30, P=0.042), and LDH (HR: 1.48, 95% CI: 1.01-2.15, P=0.043). The nomogram developed by combining these five variables and T stage demonstrated a higher C-index in both the training cohort (0.715 versus 0.624, P<0.001) and validation cohort (0.744 versus 0.629, P<0.001), as well as a higher net clinical benefit compared to the 8th edition TNM staging system (TNM-8).
CONCLUSION: The grade of CNN is a promising adverse predictor for patients with LA-NPC. Compared to the TNM-8, the nomogram incorporating the Grade of CNN demonstrates superior predictive efficacy and enhanced risk stratification.
AVAILABILITY OF DATA AND MATERIAL: The data are available from the corresponding author upon request.