The Prognostic Value of Serum Inflammatory Markers in Nasopharyngeal Carcinoma Patients Treated With Immune Checkpoint Inhibitors: A Multicenter Study.

BACKGROUND

Although immune checkpoint inhibitors (ICIs) have revolutionized the treatment of nasopharyngeal carcinoma (NPC), reliable predictive biomarkers need to be further explored. This study aimed to investigate the predictive ability of inflammatory markers for poor prognosis in NPC patients treated with ICIs.

METHODS

In this multicenter retrospective study, a total of NPC patients treated with at least two cycles of ICIs from May 2019 to December 2022 at three independent medical centers in China were included. In this study, we collected the multiple hematological parameters from patients prior to treatment to calculate serum inflammatory markers, and we performed the multivariate COX analysis to identify independent prognostic factors for constructing columnar plots. Then the ROC survival curves, calibration curves, and clinical curve analysis were used to assess the predictive performance of the model.

RESULTS

A total of 170 patients were included in the training group with a median follow-up of 26 months. Univariate and multivariate Cox regression analyses showed that Hb, Prognostic Nutritional Index (PNI), and the number of metastases were independent prognostic factors for overall survival (OS). A nomogram was constructed based on these three factors to predict the prognosis of NPC patients after ICI treatment. The nomogram achieved a C-index of 0.733 in the training cohort and 0.743 in the validation cohort, indicating good discriminative ability. Time-dependent ROC curves demonstrated favorable predictive accuracy, with area under the curve (AUC) values for 1-, 2-, and 3-year OS of 0.701, 0.756, and 0.760 in the training set, and 0.773, 0.784, and 0.777 in the validation set. The model was further validated using calibration plots and decision curve analysis (DCA), and patients were categorized into high- and low-risk groups, with the validation cohort also showing consistent survival differentiation.

CONCLUSION

The combination of serum inflammatory markers and clinicopathological factors may serve as a practical prognostic tool to predict NPC patients who may benefit from ICIs.