The value of detailed MR imaging report of primary tumor and lymph nodes on prognostic nomograms for nasopharyngeal carcinoma after intensity-modulated radiotherapy.

To establish effective prognostic nomograms using clinical features and detailed magnetic resonance imaging (MRI) findings for primary tumor and regional lymph nodes after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma. The nomogram for overall survival (OS) was based on a retrospective study of 595 patients who underwent IMRT at Sun Yat-sen University Cancer Center from 2010 to 2012. The predictive accuracy and discriminative ability of our nomogram models were determined by concordance index and calibration curve, and were compared with the nomogram models combining clinical features with tumor-node-metastasis (TNM) classification. The results were validated using bootstrap resampling and a cohort study of 241 patients. The same data cohort was used to predict the progress-free survival (PFS) of nasopharyngeal carcinoma with 3:1 training cohort (N = 558) and validation cohort (N = 278). The following factors were assembled into our prognostic survival nomogram models: Age, Epstein-Barr virus DNA copy number before treatment (EBV_DNA_CN), tensor veli palatini (TVP) involvement, musculus pterygoideus lateralis (MPL) involvement, prestyloid space (PS) involvement, prevertebral space (PVS) involvement, base of sphenoid bone (BOSB) involvement, paranasal sinus (PNS) involvement, the laterality of Ⅱ (Ⅱ_laterality), the laterality of retropharyngeal lymph node (RPLN_laterality), nodal grouping (NG), extranodal neoplastic spread (ENS), contrast-enhancing rim (CER) and Nodal_number. The calibration curves showed good agreement between nomogram-predicted and actual survival. Our nomogram models for OS and PFS, provided better results than the nomogram models combining clinical features with TNM classification. Results were further confirmed in the validation set. Detailed MRI findings of primary tumor and regional lymph nodes can improve the performance of prognostic nomograms for patients with nasopharyngeal carcinoma.

Wan Y ，Tian L ，Zhang G ，Xin H ，Li H ，Dong A ，Liang Y ，Jing B ，Zhou J ，Cui C ，Chen M ，Sun Y ，Xie C ，Liu L ，Shao Y ... -  《-》

MRI-detected residual retropharyngeal lymph node after intensity-modulated radiotherapy in nasopharyngeal carcinoma: Prognostic value and a nomogram for the pretherapy prediction of it.

To evaluate the prognostic value of MRI-detected residual retropharyngeal lymph node (RRLN) at three months after intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) and second, to establish a nomogram for the pretherapy prediction of RRLN. We included 1103 patients with NPC from two hospitals (Sun Yat-Sen University Cancer Center [SYSUCC, n = 901] and Dongguan People's Hospital [DGPH, n = 202]). We evaluated the prognostic value of RRLN using Cox regression model in SYSUCC cohort. We developed a nomogram for the pretherapy prediction of RRLN using logistic regression model in SYSUCC training cohort (n = 645). We assessed the performance of this nomogram in an internal validation cohort (SYSUCC validation cohort, n = 256) and an external independent cohort (DGPH validation cohort, n = 202). RRLN was an independent prognostic factor for OS (HR 2.08, 95% CI 1.32-3.29), DFS (HR 2.45, 95% CI 1.75-3.42), DMFS (HR 3.31, 95% CI 2.15-5.09), and LRRFS (HR 3.04, 95% CI 1.70-5.42). We developed a nomogram based on baseline Epstein-Barr virus DNA level and three RLN status-related features (including minimum axial diameter, extracapsular nodal spread, and laterality) that predicted an individual's risk of RRLN. Our nomogram showed good discrimination in the training cohort (C-index = 0.763). The favorable performance of this nomogram was confirmed in the internal and external validation cohorts. MRI-detected RRLN at three months after IMRT was an unfavorable prognostic factor for patients with NPC. We developed and validated an easy-to-use nomogram for the pretherapy prediction of RRLN.

Li WZ ，Liu GY ，Lin LF ，Lv SH ，Qiang MY ，Lv X ，Wu YS ，Liang H ，Ke LR ，Wang DL ，Yu YH ，Qiu WZ ，Liu KY ，Guo X ，Li JP ，Zou YJ ，Xiang YQ ，Xia WX ... -  《-》

Establishment and Validation of Prognostic Nomograms for Endemic Nasopharyngeal Carcinoma.

This study aimed to establish an effective prognostic nomogram with or without plasma Epstein-Barr virus DNA (EBV DNA) for nondisseminated nasopharyngeal carcinoma (NPC). The nomogram was based on a retrospective study of 4630 patients who underwent radiotherapy with or without chemotherapy at Sun Yat-sen University Cancer Center from 2007 to 2009. The predictive accuracy and discriminative ability of the nomogram were determined by a concordance index (C-index) and calibration curve and were compared with EBV DNA and the current staging system. The results were validated using bootstrap resampling and a prospective cohort study on 1819 patients consecutively enrolled from 2011 to 2012 at the same institution. All statistical tests were two-sided. Independent factors derived from multivariable analysis of the primary cohort to predict recurrence were age, sex, body mass index (BMI), T stage, N stage, plasma EBV DNA, pretreatment high sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), and hemoglobin level (HGB), which were all assembled into the nomogram with (nomogram B) or without EBV DNA (nomogram A). The calibration curve for the probability of recurrence showed that the nomogram-based predictions were in good agreement with actual observations. The C-index of nomogram B for predicting recurrence was 0.728 (P < .001), which was statistically higher than the C-index values for nomogram A (0.690), EBV DNA (0.680), and the current staging system (0.609). The C-index of nomogram B (0.730) and nomogram A (0.681) remained higher for predicting recurrence among patients treated with intensity-modulated radiotherapy (P < .001). The results were confirmed in the validation cohort. The proposed nomogram with or without plasma EBV DNA resulted in more accurate prognostic prediction for NPC patients.

Tang LQ ，Li CF ，Li J ，Chen WH ，Chen QY ，Yuan LX ，Lai XP ，He Y ，Xu YX ，Hu DP ，Wen SH ，Peng YT ，Zhang L ，Guo SS ，Liu LT ，Guo L ，Wu YS ，Luo DH ，Huang PY ，Mo HY ，Xiang YQ ，Sun R ，Chen MY ，Hua YJ ，Lv X ，Wang L ，Zhao C ，Cao KJ ，Qian CN ，Guo X ，Zeng YX ，Mai HQ ，Zeng MS ... -  《-》

Prognosis viewing for nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: application of nomogram and decision curve analysis.

To view and evaluate the prognosis factors in patients with nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy using nomogram and decision curve analysis (DCA). Based on a primary cohort comprising consecutive patients with newly confirmed NPC (n = 1140) treated between January 2014 and December 2015, we identified independent prognostic factors of overall survival (OS) to establish a nomogram. The model was assessed by bootstrap internal validation and external validation in an independent validation cohort of 460 patients treated between January 2013 and December 2013. The predictive accuracy and discriminative ability were measured by calibration curve, concordance index (C-index) and risk-group stratification. The clinical usefulness was assessed by DCA. The nomogram incorporated T-stage, N-stage, age, concurrent chemotherapy and primary tumour volume (PTV). The calibration curve presented good agreement for between the nomogram-predicted OS and the actual measured survival probability in both the primary and validation cohorts. The model showed good discrimination with a C-index of 0.741 in the primary cohort and 0.762 in the validation cohort. The survival curves of different risk-groups were separated clearly. Decision curve analysis demonstrated that the nomogram provided a higher net benefit (NB) across a wider reasonable range of threshold probabilities for predicting OS. This study presents a predictive nomogram model with accurate prediction and independent discrimination ability compared with combination of T-stage and N-stage. The results of DCA supported the point that PTV can help improve the prognostic ability of T-stage and should be added to the TNM staging system.

Fei Z ，Qiu X ，Li M ，Chen C ，Li Y ，Huang Y ... -  《-》

Prognostic Nomogram for Patients with Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy.

Wu S ，Xia B ，Han F ，Xie R ，Song T ，Lu L ，Yu W ，Deng X ，He Q ，Zhao C ，Xie C ... -  《PLoS One》