Integrating pretreatment MRI-detected nodal features and Epstein-Barr virus DNA to identify optimal candidates for intensity-modulated radiotherapy alone in patients with stage II nasopharyngeal carcinoma

• Published in: Oral oncology 2023-11, Vol.146, p.106574-106574, Article 106574
• Main Authors: Guo, Jia, He, Yun, Lin, Chao, Jiang, Qi, Xing, Hong-Wei, Zhang, Yu-Chen, Shen, Guan-Zhu, Lin, Huan-Xin, Guo, Ling, Yang, Qi
• Format: Article
• Language: English
• Subjects: Epstein-Barr virus DNA; Intensity-modulated radiation therapy; Lymph nodes; Nasopharyngeal carcinoma; Prognosis
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2023.106574

•We developed a model integrating MRI-detected features with EBV DNA to predict the PFS for patients with stage II NPC.•This combined model exhibited better predictive accuracy over the clinical-radiological model, the clinical model and the current TNM stage.•This model could distinguish the low-risk patients with stage II NPC for whom IMRT alone is sufficient. To develop and validate a prognostic nomogram based on MRI-detected features of retropharyngeal and cervical lymph nodes and Epstein–Barr virus (EBV) DNA in patients with stage II nasopharyngeal carcinoma (NPC) to distinguish low-risk patients for whom intensity-modulated radiotherapy (IMRT) alone is sufficient. This retrospective study enrolled 894 patients with stage II NPC (596 and 298 in the training and validation cohorts, respectively) with pretreatment MRI between August 2010 and May 2019. All patients received IMRT with or without additional chemotherapy. We identified independent risk factors using univariate and multivariate Cox regression analyses. Survival was compared using Kaplan–Meier curves with the log-rank test. Independent factors derived from the multivariate analysis include cervical nodal necrosis (CNN), the extracapsular spread (ECS) of cervical and retropharyngeal lymph nodes, and gamma-glutamyl transferase (γ-GGT). Nomograms A, B, and C were established based on the clinical [tumor-node-metastasis (TNM) stage + Epstein–Barr virus (EBV) DNA], the clinical-radiological [all independent predictors] and the combined models [the clinical-radiological model + EBV DNA], respectively. Nomogram C (C-index 0.769 [0.718–0.820]) demonstrated better risk discrimination than nomogram B (0.762 [0.715–0.809]), nomogram A (0.619 [0.564–0.674]), and the TNM stage (0.560 [0.509–0.611]). In the low-risk group divided by nomogram C, no significant survival differences were observed between patients treated with radiotherapy (RT) alone and other regimens including additional chemotherapy. The nomogram combining MRI-detected retropharyngeal and cervical lymph node features with pretreatment EBV-DNA improved the prognostic risk stratification for stage II NPC.