Establishment and Validation of Plasma Epstein-Barr Virus DNA-Based Prognostic Nomograms to Predict Recurrence of Primary Non-disseminated Nasopharyngeal Carcinoma in the Endemic Area
Hai-Qiang Mai1,2,3,4Lin-Quan Tang1,2,3,4Chao-Feng Li1,2,3,5Jing Li1,2,3Wen-Hui Chen1,2,3Qiu-Yan Chen1,2,3,4Lian-Xiong Yuan6Xiao-Ping Lai7Yun He7Yun-Xiu-Xiu Xu7Dong-Peng Hu7Shi-Hua Wen7Yu-Tuan Peng7Lu Zhang1,2,3,4Shan-Shan Guo1,2,3,4Li-Ting Liu1,2,3,4Ling Guo1,2,3,4Yi-Shan Wu1,2,3,4Dong-Hua Luo1,2,3,4Pei-Yu Huang1,2,3,4Hao-Yuan Mo1,2,3,4Yan-Qun Xiang1,2,3,4Rui Sun1,2,3,4Ming-Yuan Chen1,2,3,4Yi-Jun Hua1,2,3,4Xing Lv1,2,3,4Lin Wang1,2,3,4Chong Zhao1,2,3,4Ka-Jia Cao1,2,3,4Chao-Nan Qian1,2,3,4Xiang Guo1,2,3,4Yi-Xin Zeng1,2,3Mu-Sheng Zeng1,2,3
1. Sun Yat-sen University Cancer Center2. State Key Laboratory of Oncology in South China3. Collaborative Innovation Center for Cancer Medicine4. Department of Nasopharyngeal Carcinoma,the School of Public Health,Sun Yat-sen University5. Department of Information Technology,the School of Public Health,Sun Yat-sen University6. Department of Medical Statistic and Epidemiology,the School of Public Health,Sun Yat-sen University7. Zhongshan School of Medicine,Sun Yat-sen University
摘要：Purpose:This study aimed to establish an effective prognostic nomogram combining plasma Epstein-Barr Virus DNA（EBV DNA）for non-disseminated nasopharyngeal carcinoma（NPC）.Patients and Methods:The nomogram was based on a retrospective study on 4,630 patients who underwent radiotherapy with or without chemotherapy at Sun Yat-sen University Cancer Center from 2007 to2009.Thepredictive accuracy and discriminative ability of the nomogram were determined by concordanceindex（C-index）and calibration curve and compared with plasma EBV DNA and current American Joint Committee on Cancer（AJCC）staging system.The results were validated using bootstrap resampling and a prospective cohort study on 1,819 patientsconsecutively enrolled from 2011 to 2012 at the same institution.Results:Independent factors derived from multivariate analysis of the primary cohort to predict recurrence were age,gender,BMI,T stage,N stage,plasma EBV DNA,pretreatmenths-CRP,LDH,and hemoglobin level,which were all assembled intothe nomogram.The calibration curve for the probability of recurrence showed that the nomogram-based predictionswere in good agreement withactual observations.The C-index of the nomogram for predicting recurrence was 0.728（P＜0.001）,which was statistically higher than the C-index values for EBV DNA（0.680）and the AJCC stage system（0.608）.The C-index remains higher（0.730）for predicting recurrence among patients treated with Intensity-modulated radiotherapy（P＜0.001）.In the validation cohort,the nomogram discrimination（0.709）was superior to EBV DNA（0.668,P=0.009）and the AJCC staging system（0.619,P＜0.001）.Conclusion:The proposed nomogram combining plasma EBV DNA resulted in more-accurate prognostic prediction for NPC patients.