MRI-identified multidimensional nodal features: predict survival and concurrent chemotherapy benefit for stage II nasopharyngeal carcinoma

LN feature-based nomogram for stage II NPC

Abstract

Background: Reliable predictors are urgently needed to identify stage II nasopharyngeal carcinoma (NPC) patients who could benefit from concurrent chemoradiotherapy (CCRT). We aimed to develop a nomogram integrating MRI-identified multidimensional features of lymph nodes (LN) to predict survival and assist the decision-making of CCRT for stage II NPC.

Materials and methods: This retrospective study enrolled 242 stage II NPC patients treated from January 2007 to December 2017. Overall survival (OS) was the primary endpoint. Performance of nomogram was evaluated using calibration curves, Harrell Concordance Index (C-index), area under the curve (AUC) and decision curves analysis (DCA) and was compared with TNM staging. According to the individualized nomogram score, patients were classified into two risk cohorts and therapeutic efficacy of CCRT were evaluated in each cohort.

Results: Three independent prognostic factors for OS: age, number and location of positive LNs were included into the final nomogram. T stage was also incorporated due to its importance in clinical decision-making. Calibration plots demonstrated a good match between the predicted and our observed OS rates. C-index for nomogram was 0.726 compared with 0.537 for TNM staging (p < 0.001). DCAs confirm the superior clinical utility of nomograms compared with TNM staging. CCRT delivered survival benefit to patients in the high-risk group (5-year OS 89.9% vs. 72.1%; 10-year OS: 72.5% vs. 34.2%, p = 0.011), but not in the low-risk group.

Conclusion: This LN features-based nomogram demonstrated excellent discrimination and predictive accuracy for stage II patients and could identify patients who can benefit from CCRT.