A Scoring System Based on Nutritional and Inflammatory Parameters to Predict the Efficacy of First-Line Chemotherapy and Survival Outcomes for De Novo Metastatic Nasopharyngeal Carcinoma

Wang-Zhong Li; Xin Hua; Shu-Hui Lv; Hu Liang; Guo-Ying Liu; Nian Lu; Wei-Xin Bei; Wei-Xiong Xia; Yan-Qun Xiang

doi:10.2147/JIR.S296710

A Scoring System Based on Nutritional and Inflammatory Parameters to Predict the Efficacy of First-Line Chemotherapy and Survival Outcomes for De Novo Metastatic Nasopharyngeal Carcinoma

J Inflamm Res. 2021 Mar 10:14:817-828. doi: 10.2147/JIR.S296710. eCollection 2021.

Authors

Wang-Zhong Li^#^{1

2}, Xin Hua^#³, Shu-Hui Lv^#^{1

2}, Hu Liang^{1

2}, Guo-Ying Liu^{1

2}, Nian Lu^{1

2}, Wei-Xin Bei^{1

2}, Wei-Xiong Xia^{1

2}, Yan-Qun Xiang^{1

2}

Affiliations

¹ State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
² Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
³ Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: We aimed to develop a simple scoring system based on baseline inflammatory and nutritional parameters to predict the efficacy of first-line chemotherapy and survival outcomes for de novo metastatic nasopharyngeal carcinoma (mNPC).

Patients and methods: We retrospectively collected ten candidate inflammatory and nutritional parameters from de novo mNPC patients who received platinum-based first-line chemotherapy treatment. We examined the effects of these ten candidate variables on progression-free survival (PFS) using the Cox regression model. We built a risk-scoring system based on the regression coefficients associated with the identified independent prognostic factors. The predictive accuracy of the scoring system was evaluated and independently validated.

Results: A total of 460 patients were analyzed. Four independent prognostic factors were identified in a training cohort and were used to construct the scoring system, including nutritional risk index, C-reactive protein level, alkaline phosphatase level, and lactate dehydrogenase level. Based on the score obtained from the scoring system, we stratified patients into three prognostic subgroups (low: 0-1 point, intermediate: 2-3 points, and high: 4 points) associated with significantly different disease control rates (94.7% vs. 92.5% vs. 66.0%, respectively) and survival outcomes (3-year PFS: 55.8% vs. 29.1% vs. 11.9%, respectively). The scoring system had a good performance for the prediction of short-term disease control (area under the receiver operating characteristic curve [AUC]: 0.701) and long-term survival outcomes (time-dependent AUC for 5-year PFS: 0.713). The results were internally validated using an independent cohort (AUC for predicting disease control: 0.697; time-dependent AUC for 5-year PFS: 0.713).

Conclusion: We developed and validated a clinically useful risk-scoring system that could predict the efficacy of first-line chemotherapy and survival outcomes in de novo mNPC patients. This system may help clinicians to design personalized treatment strategies.

Keywords: cancer-related inflammation; chemotherapy efficacy; metastatic nasopharyngeal carcinoma; nutritional status; survival outcomes.

Grants and funding

This study is supported by the National Natural Science Foundation of China (No. 81672680 and 81802712), the Guangdong Medical Research Foundation (No. A2017492), and the Young Teacher Training Project of Sun Yat-Sen University (No. 19ykpy188).