Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

(<b>1</b>) Purpose: This study aims to explore risk-adapted treatment for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) according to their pretreatment risk stratification and the degree of comorbidity. (<b>2</b>) Methods: A total of 583 elde...

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Autores principales:	Jia Kou, Lu-Lu Zhang, Xing-Li Yang, Dan-Wan Wen, Guan-Qun Zhou, Chen-Fei Wu, Si-Si Xu, Wei-Hong Zheng, Zhen-Yu Qi, Ying Sun, Li Lin
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	nasopharyngeal carcinoma elderly patients comorbidities chemotherapy Medicine R
Acceso en línea:	https://doaj.org/article/46b4b49c0ab74614b72f9933a09ef38f
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spelling	oai:doaj.org-article:46b4b49c0ab74614b72f9933a09ef38f2021-11-25T18:06:51ZDevelopment of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma10.3390/jpm111110652075-4426https://doaj.org/article/46b4b49c0ab74614b72f9933a09ef38f2021-10-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1065https://doaj.org/toc/2075-4426(<b>1</b>) Purpose: This study aims to explore risk-adapted treatment for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) according to their pretreatment risk stratification and the degree of comorbidity. (<b>2</b>) Methods: A total of 583 elderly LA-NPC patients diagnosed from January 2011 to January 2018 are retrospectively studied. A nomogram for disease-free survival (DFS) is constructed based on multivariate Cox regression analysis. The performance of the model is evaluated by using the area under the curve (AUC) of the receiver operating characteristic curve and Harrell concordance index (C-index). Then, the entire cohort is divided into different risk groups according to the nomogram cutoff value determined by X-tile analysis. The degree of comorbidities is assessed by the Charlson Comorbidity Index (CCI). Finally, survival rates are estimated and compared by the Kaplan–Meier method and the log-rank test. (<b>3</b>) Results: A nomogram for DFS is constructed with T/N classification, Epstein-Barr virus DNA and albumin. The nomogram shows well prognostic performance and significantly outperformed the tumor-node-metastasis staging system for estimating DFS (AUC, 0.710 vs. 0.607; C-index, 0.668 vs. 0.585; both <i>p</i> < 0.001). The high-risk group generated by nomogram has significantly poorer survival compared with the low-risk group (3-year DFS, 76.7% vs. 44.6%, <i>p</i> < 0.001). For high-risk patients with fewer comorbidities (CCI = 2), chemotherapy combined with radiotherapy is associated with significantly better survival (<i>p</i> < 0.05) than radiotherapy alone. (<b>4</b>) Conclusion: A prognostic nomogram for DFS is constructed with generating two risk groups. Combining risk stratification and the degree of comorbidities can guide risk-adapted treatment for elderly LA-NPC patients.Jia KouLu-Lu ZhangXing-Li YangDan-Wan WenGuan-Qun ZhouChen-Fei WuSi-Si XuWei-Hong ZhengZhen-Yu QiYing SunLi LinMDPI AGarticlenasopharyngeal carcinomaelderly patientscomorbiditieschemotherapyMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1065, p 1065 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	nasopharyngeal carcinoma elderly patients comorbidities chemotherapy Medicine R
spellingShingle	nasopharyngeal carcinoma elderly patients comorbidities chemotherapy Medicine R Jia Kou Lu-Lu Zhang Xing-Li Yang Dan-Wan Wen Guan-Qun Zhou Chen-Fei Wu Si-Si Xu Wei-Hong Zheng Zhen-Yu Qi Ying Sun Li Lin Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
description	(<b>1</b>) Purpose: This study aims to explore risk-adapted treatment for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) according to their pretreatment risk stratification and the degree of comorbidity. (<b>2</b>) Methods: A total of 583 elderly LA-NPC patients diagnosed from January 2011 to January 2018 are retrospectively studied. A nomogram for disease-free survival (DFS) is constructed based on multivariate Cox regression analysis. The performance of the model is evaluated by using the area under the curve (AUC) of the receiver operating characteristic curve and Harrell concordance index (C-index). Then, the entire cohort is divided into different risk groups according to the nomogram cutoff value determined by X-tile analysis. The degree of comorbidities is assessed by the Charlson Comorbidity Index (CCI). Finally, survival rates are estimated and compared by the Kaplan–Meier method and the log-rank test. (<b>3</b>) Results: A nomogram for DFS is constructed with T/N classification, Epstein-Barr virus DNA and albumin. The nomogram shows well prognostic performance and significantly outperformed the tumor-node-metastasis staging system for estimating DFS (AUC, 0.710 vs. 0.607; C-index, 0.668 vs. 0.585; both <i>p</i> < 0.001). The high-risk group generated by nomogram has significantly poorer survival compared with the low-risk group (3-year DFS, 76.7% vs. 44.6%, <i>p</i> < 0.001). For high-risk patients with fewer comorbidities (CCI = 2), chemotherapy combined with radiotherapy is associated with significantly better survival (<i>p</i> < 0.05) than radiotherapy alone. (<b>4</b>) Conclusion: A prognostic nomogram for DFS is constructed with generating two risk groups. Combining risk stratification and the degree of comorbidities can guide risk-adapted treatment for elderly LA-NPC patients.
format	article
author	Jia Kou Lu-Lu Zhang Xing-Li Yang Dan-Wan Wen Guan-Qun Zhou Chen-Fei Wu Si-Si Xu Wei-Hong Zheng Zhen-Yu Qi Ying Sun Li Lin
author_facet	Jia Kou Lu-Lu Zhang Xing-Li Yang Dan-Wan Wen Guan-Qun Zhou Chen-Fei Wu Si-Si Xu Wei-Hong Zheng Zhen-Yu Qi Ying Sun Li Lin
author_sort	Jia Kou
title	Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
title_short	Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
title_full	Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
title_fullStr	Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
title_full_unstemmed	Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
title_sort	development of a nomogram model for treatment of elderly patients with locoregionally advanced nasopharyngeal carcinoma
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/46b4b49c0ab74614b72f9933a09ef38f
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Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

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