Development of a Comorbidity-Based Nomogram to Predict Survival After Salvage Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era

Run-Da Huang; Zhuang Sun; Xiao-Hui Wang; Yun-Ming Tian; Ying-Lin Peng; Jing-Yun Wang; Wei-Wei Xiao; Chun-Yan Chen; Xiao-Wu Deng; Fei Han

doi:10.3389/fonc.2020.625184

Development of a Comorbidity-Based Nomogram to Predict Survival After Salvage Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era

Front Oncol. 2021 Jan 20:10:625184. doi: 10.3389/fonc.2020.625184. eCollection 2020.

Authors

Run-Da Huang^{1

2

3

4}, Zhuang Sun^{1

2

3

4}, Xiao-Hui Wang^{1

2

3

4}, Yun-Ming Tian⁵, Ying-Lin Peng^{1

2

3

4}, Jing-Yun Wang^{1

2

3

4}, Wei-Wei Xiao^{1

2

3

4}, Chun-Yan Chen^{1

2

3

4}, Xiao-Wu Deng^{1

2

3

4}, Fei Han^{1

2

3

4}

Affiliations

¹ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
² State Key Laboratory of Oncology in South China, Guangzhou, China.
³ Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
⁴ Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
⁵ Department of Radiation Oncology, Hui Zhou Municipal Centre Hospital, Huizhou, China.

Abstract

Purpose: To assess the impact of comorbidity on treatment outcomes in patients with locally recurrent nasopharyngeal carcinoma (lrNPC) using intensity-modulated radiotherapy (IMRT) and to develop a nomogram that combines prognostic factors to predict clinical outcome and guide individual treatment.

Methods: This was a retrospective analysis of patients with lrNPC who were reirradiated with IMRT between 2003 and 2014. Comorbidity was evaluated by Adult Comorbidity Evaluation-27 grading (ACE-27). The significant prognostic factors (P < 0.05) by multivariate analysis using the Cox regression model were adopted into the nomogram model. Harrell concordance index (C-index) calibration curves were applied to assess this model.

Results: Between 2003 and 2014, 469 lrNPC patients treated in our institution were enrolled. Significant comorbidity (moderate or severe grade) was present in 17.1% of patients by ACE-27. Patients with no or mild comorbidity had a 5-year overall survival (OS) rate of 36.2 versus 20.0% among those with comorbidity of moderate or severe grade (P < 0.0001). The chemotherapy used was not significantly different in patients with lrNPC (P > 0.05). For the rT3-4 patients, the 5-year OS rate in the chemotherapy + radiation therapy (RT) group was 30.0 versus 16.7% for RT only (P = 0.005). The rT3-4 patients with no or mild comorbidity were associated with a higher 5-year OS rate in the chemotherapy + RT group than in the RT only group (32.1 and 17.1%, respectively; P=0.003). However, for the rT3-4 patients with a comorbidity (moderate or severe grade), the 5-year OS rate in the chemotherapy + RT group vs. RT alone was not significantly different (15.7 vs. 15.0%, respectively; p > 0.05). Eight independent prognostic factors identified from multivariable analysis were fitted into a nomogram, including comorbidity. The C-index of the nomogram was 0.715. The area under curves (AUCs) for the prediction of 1-, 3-, and 5-year overall survival were 0.770, 0.764, and 0.780, respectively.

Conclusion: Comorbidity is among eight important prognostic factors for patients undergoing reirradiation. We developed a nomogram for lrNPC patients to predict the probability of death after reirradiation and guide individualized management.

Keywords: comorbidity; nasopharyngeal carcinoma; prognostic nomogram; recurrent; reirradiation.