Prognostic Nomograms Of Older Adult Patients With Non-metastatic Nasopharyngeal Carcinoma Based On SEER Database And External Validation Cohort

Objective:Older adult patients with non-metastatic nasopharyngeal carcinoma(NPC)have poor outcomes relatives to younger patients.Here,we established a nomogram to predict the overall survival of older adults with NPC and inform patient management.Methods:Cases with older adult non-metastatic NPC(n = 262)were enrolled in this study;clinical data in the Surveillance,Epidemiology,and End Results database,from 2010 to 2015 severed as training cohort(n = 117)and patients from Jiangxi Cancer Hospital(n = 145)as external validation cohort.In the training cohort,univariate and multivariate Cox analysis were conducted to identify independent prognosis factors,which were further developed and incorporated into the nomogram.The predictive ability of the nomogram was evaluated using concordance index(C-index),area under the receiver operating characteristic curve(AUC),and calibration curve.Results:In the training cohort,univariate Cox analysis identified T-stage,N-stage and stage as significant prognosis factors(P<0.05).Multivariate analysis indicated that age,T-stage,N-stage,and treatment were independent prognosis factors(P<0.05).These factors will be used to construct the OS nomogram of older adult non-metastatic nasopharyngeal carcinoma.In the training cohort,the C-index for the nomogram was 0.738(95% confidence interval(CI),0.662-0.814).C-index values of the AJCC staging system(seventh edition)and(eighth edition)external validation cohorts were 0.750(95% CI,0.689-0.810)and 0.760(95% CI,0.701-0.819),respectively.The C-index of the American Joint Committee on Cancer staging system was 0.686(95% CI,0.604-0.768).Both training and external validation cohort calibration curves were closed to 45° slash.The ROC curves of both groups showed great predictive ability.Conclusions:Compared with TNM staging,this nomogram can help clinicians better predict the prognosis of older adult patients with non-metastatic NPC and effectively distinguish the high-risk and low-risk groups.