列线图
医学
鼻咽癌
内科学
一致性
肿瘤科
放射科
阶段(地层学)
核医学
放射治疗
古生物学
生物
作者
Bei-Bei Xiao,Dafeng Lin,Xiang Sun,Xu Zhang,Shan-Shan Guo,Liting Liu,Dong-Hua Luo,Rui Sun,Yihui Wen,Jibin Li,Xiaofei Lv,Lujun Han,Yuan Li,Sai-Lan Liu,Qibin Tang,Yu-Jing Liang,Xiaoyun Li,Ling Guo,Qiuyan Chen,Wei Fan
标识
DOI:10.1007/s00259-020-05128-8
摘要
This study aimed to establish an effective nomogram to predict primary distant metastasis (DM) in patients with nasopharyngeal carcinoma (NPC) to guide the application of PET/CT. In total, 3591 patients with pathologically confirmed NPC were consecutively enrolled. The nomogram was constructed based on 1922 patients treated between 2007 and 2014. Multivariate logistical regression was applied to identify the independent risk factors of DM. The predictive value of the nomogram was evaluated using the concordance index (C-index), calibration curve, probability density functions (PDFs), and clinical utility curve (CUC). The results were validated in 1669 patients enrolled from 2015 to 2016. Net reclassification improvement (NRI) was applied to compare performances of the nomogram with other clinical factors. The best cut-off value of the nomogram chosen for clinical application was analyzed. A total of 355 patients showed primary DM among 3591 patients, yielding an incidence rate of 9.9%. Sex, N stage, EBV DNA level, lactate dehydrogenase level, and hemoglobin level were independent predictive factors for primary DM. C-indices in the training and validation cohort were 0.796 (95% CI, 0.76–0.83) and 0.779 (95% CI, 0.74–0.81), respectively. The NRI indices demonstrated that this model had better predictive performance than plasma EBV DNA level and N stage. We advocate for a threshold probability of 3.5% for guiding the application of PET/CT depending on the clinical utility analyses. This nomogram is a useful tool to predict primary DM of NPC and guide the clinical application of PET/CT individually at the initial staging.
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