Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy

Jian Ji Pan, Wai Tong Ng, Jing Feng Zong, Sarah W.M. Lee, Horace C.W. Choi, Lucy L.K. Chan, Shao Jun Lin, Qiao Juan Guo, Henry C.K. Sze, Yun Bin Chen, You Ping Xiao, Wai Kuen Kan, Brian O'Sullivan, Wei Xu, Quynh Thu Le, Christine M. Glastonbury, A. Dimitrios Colevas, Randal S. Weber, William Lydiatt, Jatin P. ShahAnne W.M. Lee

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

BACKGROUND: The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. METHODS: Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups. RESULTS: A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively. CONCLUSIONS: The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307–3315.

Original languageEnglish (US)
Pages (from-to)3307-3315
Number of pages9
JournalCancer
Volume122
Issue number21
DOIs
StatePublished - Nov 15 2016

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Nasopharyngeal Neoplasms
Intensity-Modulated Radiotherapy
Nomograms
Neoplasm Staging
Neoplasms
Survival
Cancer Care Facilities
Tumor Burden
L-Lactate Dehydrogenase
Multivariate Analysis
Survival Rate
Regression Analysis
Magnetic Resonance Imaging

Keywords

  • TNM staging
  • intensity-modulated radiotherapy
  • nasopharyngeal carcinoma
  • nomogram
  • prognostication

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. / Pan, Jian Ji; Ng, Wai Tong; Zong, Jing Feng; Lee, Sarah W.M.; Choi, Horace C.W.; Chan, Lucy L.K.; Lin, Shao Jun; Guo, Qiao Juan; Sze, Henry C.K.; Chen, Yun Bin; Xiao, You Ping; Kan, Wai Kuen; O'Sullivan, Brian; Xu, Wei; Le, Quynh Thu; Glastonbury, Christine M.; Colevas, A. Dimitrios; Weber, Randal S.; Lydiatt, William; Shah, Jatin P.; Lee, Anne W.M.

In: Cancer, Vol. 122, No. 21, 15.11.2016, p. 3307-3315.

Research output: Contribution to journalArticle

Pan, JJ, Ng, WT, Zong, JF, Lee, SWM, Choi, HCW, Chan, LLK, Lin, SJ, Guo, QJ, Sze, HCK, Chen, YB, Xiao, YP, Kan, WK, O'Sullivan, B, Xu, W, Le, QT, Glastonbury, CM, Colevas, AD, Weber, RS, Lydiatt, W, Shah, JP & Lee, AWM 2016, 'Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy', Cancer, vol. 122, no. 21, pp. 3307-3315. https://doi.org/10.1002/cncr.30198
Pan, Jian Ji ; Ng, Wai Tong ; Zong, Jing Feng ; Lee, Sarah W.M. ; Choi, Horace C.W. ; Chan, Lucy L.K. ; Lin, Shao Jun ; Guo, Qiao Juan ; Sze, Henry C.K. ; Chen, Yun Bin ; Xiao, You Ping ; Kan, Wai Kuen ; O'Sullivan, Brian ; Xu, Wei ; Le, Quynh Thu ; Glastonbury, Christine M. ; Colevas, A. Dimitrios ; Weber, Randal S. ; Lydiatt, William ; Shah, Jatin P. ; Lee, Anne W.M. / Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. In: Cancer. 2016 ; Vol. 122, No. 21. pp. 3307-3315.
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abstract = "BACKGROUND: The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. METHODS: Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups. RESULTS: A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92{\%}, 84{\%}, and 58{\%}, respectively. CONCLUSIONS: The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307–3315.",
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author = "Pan, {Jian Ji} and Ng, {Wai Tong} and Zong, {Jing Feng} and Lee, {Sarah W.M.} and Choi, {Horace C.W.} and Chan, {Lucy L.K.} and Lin, {Shao Jun} and Guo, {Qiao Juan} and Sze, {Henry C.K.} and Chen, {Yun Bin} and Xiao, {You Ping} and Kan, {Wai Kuen} and Brian O'Sullivan and Wei Xu and Le, {Quynh Thu} and Glastonbury, {Christine M.} and Colevas, {A. Dimitrios} and Weber, {Randal S.} and William Lydiatt and Shah, {Jatin P.} and Lee, {Anne W.M.}",
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TY - JOUR

T1 - Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy

AU - Pan, Jian Ji

AU - Ng, Wai Tong

AU - Zong, Jing Feng

AU - Lee, Sarah W.M.

AU - Choi, Horace C.W.

AU - Chan, Lucy L.K.

AU - Lin, Shao Jun

AU - Guo, Qiao Juan

AU - Sze, Henry C.K.

AU - Chen, Yun Bin

AU - Xiao, You Ping

AU - Kan, Wai Kuen

AU - O'Sullivan, Brian

AU - Xu, Wei

AU - Le, Quynh Thu

AU - Glastonbury, Christine M.

AU - Colevas, A. Dimitrios

AU - Weber, Randal S.

AU - Lydiatt, William

AU - Shah, Jatin P.

AU - Lee, Anne W.M.

PY - 2016/11/15

Y1 - 2016/11/15

N2 - BACKGROUND: The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. METHODS: Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups. RESULTS: A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively. CONCLUSIONS: The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307–3315.

AB - BACKGROUND: The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. METHODS: Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups. RESULTS: A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively. CONCLUSIONS: The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307–3315.

KW - TNM staging

KW - intensity-modulated radiotherapy

KW - nasopharyngeal carcinoma

KW - nomogram

KW - prognostication

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