Prognostic Significance Of Common Blood Biomarkers In Nasopharyngeal Carcinoma And Establishment And Validation Of An Individualized Practical Prognostic Mode

Part 1: Prognostic Value of routine hematological biomarkers in Non-metastatic Nasopharyngeal CarcinomaBackground: The TNM system is insufficient in predicting survival for nasopharyngeal carcinoma patients.For more accurate prediction,we aimed to explore the prognostic value of routine hematological biomarkers.Methods: nine hundred and twenty-two patients at our hospital from 2013 to2015 were retrospectively reviewed,information about neutrophil to lymphocyte ratio(NLR),platelets to lymphocyte ratio(PLR),lymphocyte to monocyte ratio,(LMR),hemoglobin(Hgb),albumin,(Alb),dehydrogenase level(LDH),alkaline phosphatase(ALP),serum ferritin(SF)and EBV DNA were collected.Univariable analyses were conducted via Kaplan-Meier method and Log-rank analyses,and multivariable analyses were performed with Cox proportional hazards models.This study used binary data form and continuous data form to confirm each other to ensure the robustness of the results.Results: Regardless of the data form,NLR,PLR,LMR,Hgb,Alb,LDH,ALP,SF,EBV DNA are all related to prognosis in univariable analyses;Multivariate analyses showed that high NLR,low Alb,high LDH and high EBV DNA are independent factors of poor survival.Conclusions: These blood biomarkers provide further practical information in predicting the prognosis of nasopharyngeal carcinoma.Part 2: Predicting Survival for Non-metastatic Nasopharyngeal Carcinoma: Development and Validation of Nomograms with Routine Hematological Biomarkers Based on the Eighth Edition of AJCC/UICC Staging SystemBackground: The 8th edition of AJCC/UICC TNM staging system(TNM system)had limitations,therefore we aimed to develop and validate nomograms incorporating routine hematological biomarkers either with or without EBV DNA for overall survival(OS)and progression-free survival(PFS).We also evaluated the prognostic role of EBV DNA.Methods: 1203 patients at our hospital from 2013 to 2016 were retrospectively reviewed and divided into two parts(922 patients to primary cohort and 281 to validation cohort).Nomograms(either with or without EBV DNA)were developed and compared with other models(TNM system,TNM system with EBV DNA),via comparison the prognostic role of EBV DNA was evaluated.Internal and external validation were performed.Risk stratification was conducted with recursive partitioning analysis.Results: The variables incorporated in nomograms with EBV DNA for OS and PFS were sex,age,T category,N category,EBV DNA,albumin,neutrophil to lymphocyte ratio and lactate dehydrogenase.The nomograms without EBV DNA for OS and PFS included the same variables but without EBV DNA.The Cindex was 0.715 to OS and 0.705 to PFS in the nomogram with EBV DNA,0.709 to OS and 0.700 to PFS in the nomogram without EBV DNA,0.639 and 0.636 in TNM system,and 0.648,0.646 respectively in TNM system with EBV DNA.The patients were stratified into 4 risk groups according to the nomograms.Conclusions: The nomograms with EBV DNA and nomograms without EBV DNA provide better prognostication than the TNM system and the TNM system with EBV DNA.EBV DNA is valuable in predicting survival,but it is better to take other factors into consideration.