进展期鼻咽癌(Ⅲ-Ⅳb期)远处转移风险分析模型的构建及验证

Development and validation of a multivariate risk model for distant metastasis of advanced nasopharyngeal carcinoma

目的基于临床参数构建多参数模型以评估进展期鼻咽癌远处转移风险,为临床治疗提供决策依据。方法 2007年9月～2015年6月期间,经活检证实为鼻咽癌的AJCC分期为Ⅲ～Ⅳ期(M0)的140例患者纳入此次研究中。其中男性患者106例,女性患者34例;中位年龄为41岁;同步放化疗126例,非同步放化疗14例;诱导化疗40例。采用了LASSO(the least absolute shrinkage and selection operator)选取与进展期鼻咽癌患者远处转移最相关因素,并基于最相关因素构建预测模型。结果在总的18个临床参数中,选出了5个与进展期鼻咽癌远处转移预后最相关因素,包括治疗前血清EBV DNA,中性粒细胞计数/淋巴细胞计数(NLR),治疗前血清VCA-IgA抗体,同步放化疗,诱导化疗。基于以上5个临床参数建立的风险评估模型,风险值=1.73×EBV DNA+0.54×NLR+0.38×VCA-IgA-0.95×同步放化疗-2.37×诱导化疗+0.51,高低风险的最佳划分节点值是-0.62,预测效果显著(P<0.01)。结论进展期鼻咽癌患者远处转移风险评估模型可作为一项可靠的常规临床评估工具,能在进展期鼻咽癌患者治疗中提供决策支持。

Objective To develop a model based on the clinical variables for evaluating the risk of distant metastasis in patients with advanced nasopharyngeal carcinoma(NPC). Methods From September, 2007 to June, 2015, a total of 238 consecutive patients with biopsy-proven NPC in stage Ⅲ-Ⅳ(M0) based on the AJCC TNM staging manual were enrolled in this study,including 106 male and 34 female patients with a median age of 45 years(range 18-68 years). In this cohort, 126 patients received concurrent chemoradiotherapy, and 24 received chemotherapy and radiotherapy, and 40 had induction chemotherapy. We used the least absolute shrinkage and selection operator(LASSO) method to select the most significant features for establishing the model for assessing the risks of distant metastasis. Results Among the 18 clinical variables tested,5 were significantly associated with distant metastasis in advanced NPC, including plasma Epstein-Barr virus(EBV) DNA,neutrophil/lymphocytes(NLR), VCA-IgA, concurrent chemoradiotherapy, and induction chemotherapy. Based on these 5 clinical variables, we established the following model: risk score=1.73×EBV DNA+0.54×NLR+0.38×VCA-IgA-0.95×concurrent chemoradiotherapy-2.37×induction chemotherapy + 0.51. The cutoff point of this model was-0.62, which classified the patients into high-risk and low-risk groups for distant metastasis. This model showed a good performance in predicting distant metastasis in patients with advanced NPC(P<0.01). Conclusion The model we established herein can be used for evaluating the risks of distant metastasis in patients with advanced NPC and provides assistance in the clinical decision-making on individualized treatment strategy.