免疫炎症和营养指标在局部晚期鼻咽癌中的预后意义

文献信息

中文摘要

目的： 本研究旨在评估免疫炎症和营养生物标志物在局部晚期鼻咽癌（LA-NPC）患者中的预后相关性。
方法： 这项回顾性分析纳入了267例患者。我们采用主成分分析（PCA）进行降维。生存结局的评估依赖于Kaplan-Meier曲线分析。进行多因素Cox回归以确定独立预后因素，从而促进后续列线图的开发。使用校准曲线和决策曲线分析（DCA）评估列线图的预测准确性。使用Bootstrap重采样方法进行内部验证，迭代1000次。
结果： PCA得出两个主要成分，包括C1（免疫炎症指数）和C2（营养指数）。C2的截断值为-0.242。C2高（≥ -0.242）的患者生存率显著优于C2低（< -0.242）的患者。多因素分析确认年龄、T分期、乳酸脱氢酶水平和C2为独立预测因素。所得列线图显示出强大的预测准确性，一致性指数（C-index）为0.738，且校准良好。DCA表明与常规治疗策略相比，净临床获益更大。使用Bootstrap重采样方法，偏差校正的C-index为0.7177。使用列线图的风险评分，患者被分为低风险和高风险组，低风险组显示出显著更优的生存率。高风险患者在放疗或同步放化疗（RT/CCRT）前接受诱导化疗，其总生存率和局部区域无复发生存率的获益显著大于单独RT/CCRT。相比之下，对于低风险个体，两种治疗方法的疗效相当。
结论： C2是LA-NPC中可靠的预后标志物。所开发的列线图能够实现个性化风险评估，并有助于制定个体化治疗方案的临床决策。

英文摘要

OBJECTIVE: This investigation was conducted to evaluate the prognostic relevance of immune-inflammatory and nutritional biomarkers in patients diagnosed with locoregionally advanced nasopharyngeal carcinoma (LA-NPC).
METHODS: This retrospective analysis included 267 patients. We utilized principal component analysis (PCA) for dimensionality reduction. The estimation of survival outcomes relied on Kaplan-Meier curve analysis. Multivariate Cox regression was performed to pinpoint independent prognostic factors, which facilitated the subsequent development of a nomogram. The predictive accuracy of the nomogram was evaluated using calibration curves alongside decision curve analysis (DCA). Internal validation was performed using the bootstrap resampling method with 1,000 iterations.
RESULTS: PCA yielded two major components, including C1 (immune-inflammatory index) and C2 (nutritional index). The cut-off value of C2 was -0.242. Patients with high C2 (≥ -0.242) exhibited significantly better survival than those with a low C2 (< -0.242). Multivariate analysis confirmed age, T stage, lactate dehydrogenase level, and C2 as independent predictors. The resulting nomogram demonstrated strong predictive accuracy, with a concordance index (C-index) of 0.738, and was well-calibrated. DCA indicated a greater net clinical benefit compared to conventional treatment strategies. The bias-corrected C-index was 0.7177 using the bootstrap resampling method. Using the nomogram's risk score, patients were divided into low- and high-risk groups, with the low-risk group showing significantly superior survival. High-risk patients receiving induction chemotherapy before radiotherapy or concurrent chemoradiotherapy (RT/CCRT) experienced significantly greater gains in overall survival and locoregional relapse-free survival than RT/CCRT alone. By contrast, for low-risk individuals, equivalent efficacy was observed following either treatment approach.
CONCLUSION: The C2 represents a reliable prognostic marker in LA-NPC. The developed nomogram enables personalized risk evaluation and aids in clinical decisions regarding tailored therapeutic approaches.