Competing risk nomograms for nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data, intelligence platform-based analysis.
Radiother Oncol
; 129(2): 389-395, 2018 11.
Article
en En
| MEDLINE
| ID: mdl-30270098
ABSTRACT
BACKGROUND AND PURPOSE:
Lacking quantitative evaluations of competing risk data of nasopharyngeal carcinoma (NPC), we aimed to evaluate the probability of NPC- and other cause-specific mortality (NPC-SM; OCSM) and develop competing risk nomograms to quantify survival differences. MATERIAL ANDMETHOD:
Using the institutional big-data intelligence platform, 7251 NPC patients undergoing intensity-modulated radiotherapy between 2009-2014 were identified to establish nomograms based on Fine and Gray's competing risk analysis.RESULTS:
The 5-year NPC-SM and OCSM of the cohort were 13.1% and 1.2%, respectively, and elevated 5-year OCSMs were observed in patients aged ≥65â¯years (5.5%) or with severe comorbidities (4.3%). Age was most predictive of OCSM patients aged 55-64 and ≥65â¯years exhibited subdistribution hazard ratios (SHRs) of 2.70 (95% confidence interval [CI], 1.64-4.4; Pâ¯<â¯.001) and 5.78 (95% CI, 3.32-10.08; Pâ¯<â¯.001), respectively. Comorbidity measured using the Charlson Comorbidity Index (CCI) was also strongly predictive of OCSM patients with CCI scores of 1 and ≥2 exhibited SHRs of 2.33 (95% CI, 1.46-3.71; Pâ¯<â¯.001) and 2.58 (95% CI, 1.16-5.73; Pâ¯=â¯.020), respectively. All validated factors were integrated into the competing nomograms age, sex, histology type, tumor and node stages, plasma Epstein-Barr virus-DNA level, lactate dehydrogenase level, and C-reactive protein (CRP) level into the NPC-SM model (concordance [c]-indexâ¯=â¯0.743); and age, CCI, Albumin level, and CRP level into the OCSM model (c-indexâ¯=â¯0.793).CONCLUSION:
OCSM represents a significant competing event for NPC-SM in elderly patients and patients with comorbidities. We present the first prognostic nomograms to quantify competing risks, which may help to tailor individualized treatment.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Nasofaríngeas
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Nomogramas
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Radioterapia de Intensidad Modulada
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Carcinoma Nasofaríngeo
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Child
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Asia
Idioma:
En
Revista:
Radiother Oncol
Año:
2018
Tipo del documento:
Article