Establishment and Validation of Prognostic Nomograms for Endemic Nasopharyngeal Carcinoma
PUBLISHED: 2016-02-14  5000 total views, 1 today

Lin-Quan Tang1,2,*Chao-Feng Li1,*, Jing Li1,*, Wen-Hui Chen1,*, Qiu-Yan Chen1,2Lian-Xiong Yuan3, Xiao-Ping Lai4Yun He4Yun-Xiu-Xiu Xu4Dong-Peng Hu4Shi-Hua Wen4Yu-Tuan Peng4Lu Zhang1,2Shan-Shan Guo1,2Li-Ting Liu1,2Ling Guo1,2,Yi-Shan Wu1,2Dong-Hua Luo1,2Pei-Yu Huang1,2Hao-Yuan Mo1,2Yan-Qun Xiang1,2Rui Sun1,2Ming-Yuan Chen1,2Yi-Jun Hua1,2Xing Lv1,2Lin Wang1,2Chong Zhao1,2Ka-Jia Cao1,2,Chao-Nan Qian1,2Xiang Guo1,2Yi-Xin Zeng1,Hai-Qiang Mai1,2, and Mu-Sheng Zeng1,

Author Affiliations 

1Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine

2Department of Nasopharyngeal Carcinoma; 

3Department of Information Technology (CFL), Department of Medical Statistics and Epidemiologythe School of Public Health, Sun Yat-sen University, GuangzhouGuangdong, China;

4ZhongShan School of Medicine, Sun Yat-sen University, GuangzhouGuangdong, China.

*Authors contributed equally to this work.

Authors contributed equally to this work.

Corresponding author: 

Mu-Sheng Zeng, MD, PhD, Department of Experimental Research, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P. R. China (


Background: This study aimed to establish an effective prognostic nomogram with or without plasma Epstein-Barr virus DNA (EBV DNA) for nondisseminated nasopharyngeal carcinoma (NPC).

Methods: The nomogram was based on a retrospective study of 4630 patients who underwent radiotherapy with or without chemotherapy at Sun Yat-sen University Cancer Center from 2007 to 2009. The predictive accuracy and discriminative ability of the nomogram were determined by a concordance index (C-index) and calibration curve and were compared with EBV DNA and the current staging system. The results were validated using bootstrap resampling and a prospective cohort study on 1819 patients consecutively enrolled from 2011 to 2012 at the same institution. All statistical tests were two-sided.

Results: Independent factors derived from multivariable analysis of the primary cohort to predict recurrence were age, sex, body mass index (BMI), T stage, N stage, plasma EBV DNA, pretreatment high sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), and hemoglobin level (HGB), which were all assembled into the nomogram with (nomogram B) or without EBV DNA (nomogram A). The calibration curve for the probability of recurrence showed that the nomogram-based predictions were in good agreement with actual observations. The C-index of nomogram B for predicting recurrence was 0.728 (P < .001), which was statistically higher than the C-index values for nomogram A (0.690), EBV DNA (0.680), and the current staging system (0.609). The C-index of nomogram B (0.730) and nomogram A (0.681) remained higher for predicting recurrence among patients treated with intensity-modulated radiotherapy (P < .001). The results were confirmed in the validation cohort.

Conclusions: The proposed nomogram with or without plasma EBV DNA resulted in more accurate prognostic prediction for NPC patients.

Disclaimer: Only abstract of articles from non-members were published. This page aims to promote Chinese scientific research. There is no conflicts of interest with any journals reserved the copyright. For more please contact the author.

Dr.Zeng Musheng
+ Author Profile

Dr. Zeng Musheng 

Deputy Director and Vice-President of SunYat-sen University Cancer Center.


Pathogenesis, early diagnosisand prognosis of cancer.

Research Achievements

Established tumor virology and tumor molecular markers research group.

First completed nasopharyngeal carcinoma (NPC) associated EBV sequence analysis, and found NPC-associated HBV sequence features.



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