摘要
目的通过建立基于p16阴性鼻咽癌患者临床生化参数的列线图模型,识别可在同步放化疗(concurrent chemoradiotherapy,CCRT)联合诱导化疗(induction chemotherapy,IC)中获益的人群。方法回顾性纳入黄冈市中心医院2021年6月~2024年5月间接受CCRT的142例鼻咽癌患者进行分析,将患者以7∶3的比例分为训练集(n=99)和验证集(n=43)。治疗前,所有患者均接受完整的体格检查、纤维鼻咽镜检查、实验室检查和血浆水平检测。研究终点是疾病特异性生存期(disease-specific survival,DSS),定义为从初始治疗到癌症相关死亡或最后一次随访日期的时间。结果通过Cox及LASSO回归分析筛选出EBV-DNA水平、T分级、N分级、白蛋白、乳酸脱氢酶建立预测鼻咽癌患者DSS的列线图模型。列线图模型在训练集及验证集中均有良好的区分能力[C-index值:0.947(95%CI:0.905~0.990)vs.0.930(95%CI:0.862~0.998)]及准确性。列线图模型按风险分为低危组、中危组、高危组,在训练集及验证集中三组DSS存在统计学差异(χ^(2)=7.153、9.266,P=0.028、0.010)。在训练集中也仅有高危组接受IC+CCRT的患者DSS长于接受CCRT患者。结论通过治疗前EBV-DNA水平、T分级、N分级、白蛋白、乳酸脱氢酶的列线图模型区分出高危老年人群p16阴性鼻咽癌患者,提示该人群可能是临床中IC+CCRT的获益人群。
OBJECTIVE To establish a nomogram model based on clinical and biochemical parameters in elderly patients with p16-negative nasopharyngeal carcinoma and to identify patients who may benefit from concurrent chemoradiotherapy(CCRT)combined with induction chemotherapy(IC).METHODS A total of 142 nasopharyngeal carcinoma patients who received CCRT in Huanggang Central Hospital between June 2021 and May 2024 were retrospectively included for analysis,and the patients were divided into a training set(n=99)and a validation set(n=43)in a ratio of 7:3.Before treatment,all patients underwent a complete physical examination,fiberoptic nasopharyngeal endoscopy,laboratory tests,and plasma Epstein-Barr virus deoxyribonucleic acid(EBV-DNA)level detection.The study endpoint was disease-specific survival(DSS),defined as the time from initial treatment to cancer-related death or the last follow-up date.RESULTS EBV-DNA level,T stage,N stage,albumin(ALB),and lactate dehydrogenase(LDH)were screened by COX and LASSO regression analysis to establish a nomogram model for predicting DSS in nasopharyngeal carcinoma patients.The nomogram model had good discrimination ability[C-index value:0.947(95%CI:0.905-0.990)vs.0.930(95%CI:0.862-0.998)]and accuracy in both the training set and the validation set.The nomogram model was divided into low-risk group,medium-risk group and high-risk group according to risk.There were statistical differences in DSS among the three groups in the training set and validation set(χ^(2)=7.153,9.266,P=0.028,0.010).In the training set and validation set,only the patients in the high-risk group who received IC+CCRT had a longer DSS than those who received CCRT.CONCLUSION The nomogram model of pre-treatment EBV-DNA level,T stage,N stage,ALB,and LDH was used to distinguish high-risk elderly p16-negative nasopharyngeal carcinoma patients,suggesting that this population may be the beneficiary of IC+CCRT in clinical practice.
作者
吴晓峰
赵建红
李思维
万龙
王水斌
WU Xiaofeng;ZHAO Jianhong;LI Siwei;WAN Long;WANG Shuibin(Department of Otolaryngology Head and Neck Surgery,Huanggang Central Hospital,Huanggang,Hubei,438000,China;Department of Pathology,Huanggang Central Hospital,Huanggang,Hubei,438000,China;Department of Oncology,Huanggang Central Hospital,Huanggang,Hubei,438000,China)
出处
《中国耳鼻咽喉头颈外科》
2025年第7期432-438,共7页
Chinese Archives of Otolaryngology-Head and Neck Surgery
基金
湖北省卫生健康科技项目(HGYYMS09)。
关键词
鼻咽癌
老年人
诱导化疗
列线图
模型
同步放化疗
p16阴性
Nasopharyngeal Carcinoma
Aged
Induction Chemotherapy
Nomograms
Models
concurrent chemoradiotherapy
p16 negative
