Prognostic Analysis of Nonmetastatic Nasopharyngeal Carcinoma in Older Patients Undergoing Intensity-Modulated Radiotherapy

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2024-12-24 DOI:10.1155/ijcp/8833803

Shuangyue Wang, Heqing Huang, Fengqiao Huang, Haiyan Wu, Zhiru Li, Ziyan Zhou, Min Kang

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引用次数: 0

Abstract

Background: We investigated a visual model for estimating prognosis in older patients with nonmetastatic nasopharyngeal carcinoma (NPC) and analyzed the survival rates in different patient groups during intensity-modulated radiotherapy (IMRT).

Methods: Between January 2012 and March 2021, patients with NPC aged > 65 years who received IMRT and were initially diagnosed with no distant metastases were enrolled. Propensity score analysis with 1:1 matching was used to balance baseline characteristics, including age, sex, tumor stage, and comorbidities. Kaplan–Meier analysis was used to calculate survival. Cox regression analysis was used to identify independent prognostic factors for overall survival (OS). A nomogram was constructed based on the determined prognostic factors, and prediction accuracy was evaluated using receiver operating characteristic (ROC) and calibration curves.

Results: In total, 140 patients were included in the analysis (median age: 69 years; range: 66–81 years). The median follow-up was 84.9 (26.2–131.5) months. Compared with radiotherapy (RT) alone, chemotherapy during RT failed to improve OS (54.2% vs. 50.0%, respectively; p = 0.969), cancer-specific survival (CSS) (59.1% vs. 60.5%, respectively; p = 0.712), distant metastasis–free survival (DMFS) (66.7% vs. 70.5%, respectively; p = 0.824), or locoregional relapse–free survival (LRFS) (85.0% vs. 86.9%, respectively; p = 0.811). After the final regression analysis, age, age-adjusted Charlson comorbidity index (ACCI) score, N stage, and total stage were identified as independent factors affecting OS prognosis. The OS nomogram was applied to the data and, based on the value of the area under the ROC and calibration curves, demonstrated satisfactory predictive performance.

Conclusions: Survival outcomes in older patients with NPC treated with RT alone were similar to those in patients treated with both chemotherapy and RT. Our nomogram had good performance in predicting OS in older patients with NPC and may benefit the clinical decision-making process.

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接受调强放疗的老年鼻咽癌非转移性预后分析

背景：我们研究了一种用于估计老年非转移性鼻咽癌（NPC）患者预后的视觉模型，并分析了不同患者组在调强放疗（IMRT）期间的生存率。方法：2012年1月至2021年3月期间，年龄为>；65名接受IMRT且最初诊断为无远处转移的患者被纳入研究。采用1:1匹配的倾向评分分析来平衡基线特征，包括年龄、性别、肿瘤分期和合并症。Kaplan-Meier分析计算生存率。采用Cox回归分析确定影响总生存期（OS）的独立预后因素。根据确定的预后因素构建nomogram，并利用受试者工作特征（receiver operating characteristic， ROC）和校准曲线对预测精度进行评价。结果：共纳入140例患者(中位年龄：69岁；年龄范围：66-81岁)。中位随访时间为84.9（26.2-131.5）个月。与单纯放疗（RT）相比，RT期间化疗未能改善OS(分别为54.2%和50.0%；p = 0.969)，癌症特异性生存率（CSS）分别为59.1%∶60.5%；p = 0.712)，远处无转移生存率（DMFS）(分别为66.7% vs. 70.5%；p = 0.824)，或局部无复发生存率（LRFS）(分别为85.0%和86.9%；P = 0.811)。最终回归分析，年龄、年龄校正Charlson合并症指数（ACCI）评分、N分期、总分期为影响OS预后的独立因素。将OS nomogram应用于数据，基于ROC下面积和校准曲线的值，显示出令人满意的预测性能。结论：单独接受放疗的老年鼻咽癌患者的生存结果与同时接受化疗和放疗的患者相似。我们的nomogram （nomogram）在预测老年鼻咽癌患者的OS方面表现良好，可能有利于临床决策过程。

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来源期刊

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.