Supplementary value of primary tumor volume for prognostic stratification in patients with T3‑4 nasopharyngeal carcinoma: A retrospective cohort study
Year: 2026
Type: supplementary-materials
Abstract: The present retrospective study evaluated the supplementary value of gross tumor volume of the primary nasopharyngeal tumor (GTVnx) for overall survival (OS) risk stratification in patients with T3-4 nasopharyngeal carcinoma (NPC).A total of 118 patients with T3-4 NPC who received definitive intensity-modulated radiotherapy at Guilin People's Hospital (Guilin, China) between March 2020 and June 2025 were included.GTVnx was obtained from the radiotherapy planning system.A time-dependent receiver operating characteristic (ROC) curve was used to determine the exploratory cut-off for predicting 3-year OS.Survival differences were assessed using the Kaplan-Meier method and log-rank test, and Cox proportional hazards models were used to evaluate the association between GTVnx and OS.Clinical and extended models were compared using the concordance index (C-index), Akaike information criterion (AIC) and time-dependent area under the curve (AUC), and sensitivity analyses were performed to assess robustness.The median follow-up time was 34.1 months and 18 deaths occurred (15.3%).The 36-month time-dependent ROC analysis identified 78 cm 3 as the exploratory cut-off for GTVnx, with an AUC of 0.709.Patients with high GTVnx had poorer OS than those with low GTVnx (log-rank P<0.001).In a multivariable Cox analysis, high GTVnx remained associated with poorer OS after adjustment for T stage and pretreatment Epstein-Barr virus DNA (EBV DNA; hazard ratio, 4.375; 95% confidence interval, 1.474-12.986;P= 0.008).Adding GTVnx to the clinical model improved the C-index from 0.759 to 0.817, reduced the AIC from 135.151 to 133.085 and increased the 36-month AUC from 0.748 to 0.787.Sensitivity analyses supported the consistency of the main findings.GTVnx may provide supplementary prognostic information beyond T stage and pretreatment EBV DNA in patients with T3-4 NPC.However, the identified cut-off value and incremental prognostic value require validation in independent cohorts.
Source: Oncology Letters
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221716574