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

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.