Development and Validation of a Nomogram Based on the Different Grades of Cervical Lymph Node Necrosis to Predict Overall Survival in Patients with Lymph Node-Positive Locally Advanced Nasopharyngeal Carcinoma

IF 3.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Academic Radiology Pub Date : 2025-03-06 DOI:10.1016/j.acra.2025.02.034

Run-Zhi Wang , Li-Ru Zhu , Yao-Can Xu , Mei-Wen Chen , Zhong-Guo Liang , Kai-Hua Chen , Ling Li , Xiao-Dong Zhu

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Abstract

Rationale and Objectives

This study aims to quantitatively evaluate the clinical significance of different grades of cervical lymph node necrosis (CNN). Furthermore, a nomogram was developed and validated to predict overall survival (OS) in patients with lymph node-positive (LN-positive) locally advanced nasopharyngeal carcinoma (LA-NPC), incorporating the different grades of CNN.

Patients and Methods

We retrospectively analyzed patients with newly diagnosed, LN-positive LA-NPC at our center from April 2014 to December 2018. Independent predictors were identified through Cox regression analyses, which examined the grade of CNN and other clinical variables associated with OS. Based on the results and a key clinical variable, a nomogram was developed to predict OS. Model performance was evaluated through discrimination, calibration, and clinical utility. Risk stratification was performed using the risk score derived from the nomogram, and the prognoses of two distinct risk groups were compared using the Kaplan–Meier method.

Results

A total of 984 patients were enrolled. Independent predictors for OS, confirmed by multivariate Cox analysis, included age (hazard ratio [HR]: 1.57, 95% CI: 1.09–2.26, P = 0.016), Epstein–Barr virus (EBV) DNA (HR: 2.02, 95% CI: 1.40–2.92, P<0.001), N3 (HR: 2.30, 95% CI: 1.42–3.72, P = 0.001), Grade of CNN (HR: 1.53, 95% CI: 1.02–2.30, P=0.042), and LDH (HR: 1.48, 95% CI: 1.01–2.15, P = 0.043). The nomogram developed by combining these five variables and T stage demonstrated a higher C-index in both the training cohort (0.715 versus 0.624, P<0.001) and validation cohort (0.744 versus 0.629, P<0.001), as well as a higher net clinical benefit compared to the 8th edition TNM staging system (TNM-8).

Conclusion

The grade of CNN is a promising adverse predictor for patients with LA-NPC. Compared to the TNM-8, the nomogram incorporating the Grade of CNN demonstrates superior predictive efficacy and enhanced risk stratification.

Availability of Data and Material

The data are available from the corresponding author upon request.

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基于不同程度颈部淋巴结坏死的Nomogram预测淋巴结阳性局部晚期鼻咽癌患者总生存期的发展和验证。

理由与目的：本研究旨在定量评价不同程度颈部淋巴结坏死（CNN）的临床意义。此外，我们开发并验证了一个nomogram来预测淋巴结阳性（ln阳性）局部晚期鼻咽癌（LA-NPC）患者的总生存期（OS），该nomogram包含了不同级别的CNN。患者和方法：回顾性分析2014年4月至2018年12月在本中心新诊断的ln阳性LA-NPC患者。通过Cox回归分析确定独立预测因素，该分析检查了CNN的分级和其他与OS相关的临床变量。根据结果和一个关键的临床变量，开发了一个nomogram来预测OS。通过鉴别、校准和临床应用来评估模型的性能。使用从nomogram得出的风险评分进行风险分层，并使用Kaplan-Meier方法比较两个不同风险组的预后。结果：共纳入984例患者。多因素Cox分析证实，OS的独立预测因素包括年龄（风险比[HR]: 1.57, 95% CI: 1.09-2.26， P=0.016）、eb病毒（EBV） DNA（风险比[HR]: 2.02, 95% CI: 1.40-2.92， P）。结论：CNN分级是LA-NPC患者有希望的不良预测因素。与TNM-8相比，纳入CNN分级的nomogram预测效果更佳，风险分层更强。数据和材料的可获得性：数据可根据要求从通讯作者处获得。

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来源期刊

Academic Radiology 医学-核医学

CiteScore

7.60

自引率

10.40%

发文量

432

审稿时长

18 days

期刊介绍： Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.