Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma

Authors: Lin Yang, Liangping Xia, Yan Wang, Shasha He, Haiyang Chen, Shaobo Liang, Peijian Peng, Shaodong Hong, Yong Chen

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

The skeletal system is the most common site of distant metastasis in nasopharyngeal carcinoma (NPC); various prognostic factors have been reported for skeletal metastasis, though most studies have focused on a single factor. We aimed to establish nomograms to effectively predict skeletal metastasis at initial diagnosis (SMAD) and skeletal metastasis-free survival (SMFS) in NPC.

Methods

A total of 2685 patients with NPC who received bone scintigraphy (BS) and/or 18F–deoxyglucose positron emission tomography/computed tomography (18F–FDG PET/CT) and 2496 patients without skeletal metastasis were retrospectively assessed to develop individual nomograms for SMAD and SMFS. The models were validated externally using separate cohorts of 1329 and 1231 patients treated at two other institutions.

Results

Five independent prognostic factors were included in each nomogram. The SMAD nomogram had a significantly higher c-index than the TNM staging system (training cohort, P = 0.005; validation cohort, P < 0.001). The SMFS nomogram had significantly higher c-index values in the training and validation sets than the TNM staging system (P < 0.001 and P = 0.005, respectively). Three proposed risk stratification groups were created using the nomograms, and enabled significant discrimination of SMFS for each risk group.

Conclusion

The prognostic nomograms established in this study enable accurate stratification of distinct risk groups for skeletal metastasis, which may improve counseling and facilitate individualized management of patients with NPC.
Appendix
Available only for authorised users
Literature
1.
Cao SM, Simons MJ, Qian CN. The prevalence and prevention of nasopharyngeal carcinoma in China. Chinese J Cancer. 2011;30(2):114–9.CrossRef
2.
Fong KW, Chua EJ, Chua ET, Khoo-Tan HS, Lee KM, Lee KS, Sethi VK, Tan BC, Tan TW, Wee J, et al. Patient profile and survival in 270 computer tomography-staged patients with nasopharyngeal cancer treated at the Singapore General Hospital. Ann Acad Med Singap. 1996;25(3):341–6.PubMed
3.
Heng DM, Wee J, Fong KW, Lian LG, Sethi VK, Chua ET, Yang TL, Khoo Tan HS, Lee KS, Lee KM, et al. Prognostic factors in 677 patients in Singapore with nondisseminated nasopharyngeal carcinoma. Cancer. 1999;86(10):1912–20.CrossRefPubMed
4.
Tan EH, Khoo KS, Wee J, Fong KW, Lee KS, Lee KM, Chua ET, Tan T, Khoo-Tan HS, Yang TL, et al. Phase II trial of a paclitaxel and carboplatin combination in Asian patients with metastatic nasopharyngeal carcinoma. Ann Oncol. 1999;10(2):235–7.CrossRefPubMed
5.
Fandi A, Bachouchi M, Azli N, Taamma A, Boussen H, Wibault P, Eschwege F, Armand JP, Simon J, Cvitkovic E. Long-term disease-free survivors in metastatic undifferentiated carcinoma of nasopharyngeal type. J Clin Oncol. 2000;18(6):1324–30.CrossRefPubMed
6.
Algra PR, Bloem JL, Tissing H, Falke TH, Arndt JW, Verboom LJ. Detection of vertebral metastases: comparison between MR imaging and bone scintigraphy. Radiographics. 1991;11(2):219–32.CrossRefPubMed
7.
Liu FY, Chang JT, Wang HM, Liao CT, Kang CJ, Ng SH, Chan SC, Yen TC. [18F]fluorodeoxyglucose positron emission tomography is more sensitive than skeletal scintigraphy for detecting bone metastasis in endemic nasopharyngeal carcinoma at initial staging. J Clin Oncol. 2006;24(4):599–604.CrossRefPubMed
8.
Tsuya A, Kurata T, Tamura K, Fukuoka M. Skeletal metastases in non-small cell lung cancer: a retrospective study. Lung cancer. 2007;57(2):229–32.CrossRefPubMed
9.
Sun JM, Ahn JS, Lee S, Kim JA, Lee J, Park YH, Park HC, Ahn MJ, Ahn YC, Park K. Predictors of skeletal-related events in non-small cell lung cancer patients with bone metastases. Lung cancer. 2011;71(1):89–93.CrossRefPubMed
10.
Sekine I, Nokihara H, Yamamoto N, Kunitoh H, Ohe Y, Tamura T. Risk factors for skeletal-related events in patients with non-small cell lung cancer treated by chemotherapy. Lung cancer. 2009;65(2):219–22.CrossRefPubMed
11.
Delea T, Langer C, McKiernan J, Liss M, Edelsberg J, Brandman J, Sung J, Raut M, Oster G. The cost of treatment of skeletal-related events in patients with bone metastases from lung cancer. Oncology. 2004;67(5–6):390–6.PubMed
12.
Min JW, Um SW, Yim JJ, Yoo CG, Han SK, Shim YS, Kim YW. The role of whole-body FDG PET/CT, Tc 99m MDP bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer. J Korean Med Sci. 2009;24(2):275–80.CrossRefPubMedPubMedCentral
13.
Schindler F, Lajolo PP, Pinczowski H, Fonseca FL, Barbieri A, Massonetto LH, Katto FT, Del Giglio A. Bone and total alkaline phosphatase for screening skeletal metastasis in patients with solid tumours. European J Cancer Care. 2008;17(2):152–6.CrossRef
14.
Bashiri A, Katz O, Maor E, Sheiner E, Pack I, Mazor M. Positive placental staining for alkaline phosphatase corresponding with extreme elevation of serum alkaline phosphatase during pregnancy. Arch Gynecol Obstet. 2007;275(3):211–4.CrossRefPubMed
15.
Al Mamari S, Djordjevic J, Halliday JS, Chapman RW. Improvement of serum alkaline phosphatase to <1.5 upper limit of normal predicts better outcome and reduced risk of cholangiocarcinoma in primary sclerosing cholangitis. J Hepatol. 2013;58(2):329–34.CrossRefPubMed
16.
Damera S, Raphael KL, Baird BC, Cheung AK, Greene T, Beddhu S. Serum alkaline phosphatase levels associate with elevated serum C-reactive protein in chronic kidney disease. Kidney Int. 2011;79(2):228–33.CrossRefPubMed
17.
Lu Y, Lu Q, Chen HL. Diagnosis of primary liver cancer using lectin affinity chromatography of serum alkaline phosphatase. J Exp Clin Cancer Res. 1997;16(1):75–80.PubMed
18.
Sonpavde G, Pond GR, Berry WR, de Wit R, Armstrong AJ, Eisenberger MA, Tannock IF. Serum alkaline phosphatase changes predict survival independent of PSA changes in men with castration-resistant prostate cancer and bone metastasis receiving chemotherapy. Urol Oncol. 2012;30(5):607–13.CrossRefPubMed
19.
Yang L, Hong S, Wang Y, He Z, Liang S, Chen H, He S, Wu S, Song L, Chen Y. A novel prognostic score model incorporating CDGSH iron sulfur Domain2 (CISD2) predicts risk of disease progression in laryngeal squamous cell carcinoma. Oncotarget. 2016;7(16):22720–32
20.
21.
Axelson H, Fredlund E, Ovenberger M, Landberg G, Pahlman S. Hypoxia-induced dedifferentiation of tumor cells--a mechanism behind heterogeneity and aggressiveness of solid tumors. Semin Cell Dev Biol. 2005;16(4–5):554–63.CrossRefPubMed
22.
Colgan SM, Mukherjee S, Major P. Hypoxia-induced lactate dehydrogenase expression and tumor angiogenesis. Clin Colorectal Cancer. 2007;6(6):442–6.CrossRefPubMed
23.
24.
25.
Stubbs M, McSheehy PM, Griffiths JR, Bashford CL. Causes and consequences of tumour acidity and implications for treatment. Mol Med Today. 2000;6(1):15–9.CrossRefPubMed
26.
McDermott AL, Dutt SN, Watkinson JC. The aetiology of nasopharyngeal carcinoma. Clinical otolaryngology and allied sciences. 2001;26(2):82–92.CrossRefPubMed
27.
Lo YM, Chan AT, Chan LY, Leung SF, Lam CW, Huang DP, Johnson PJ. Molecular prognostication of nasopharyngeal carcinoma by quantitative analysis of circulating Epstein-Barr virus DNA. Cancer Res. 2000;60(24):6878–81.PubMed
28.
Leung SF, Zee B, Ma BB, Hui EP, Mo F, Lai M, Chan KC, Chan LY, Kwan WH, Lo YM, et al. Plasma Epstein-Barr viral deoxyribonucleic acid quantitation complements tumor-node-metastasis staging prognostication in nasopharyngeal carcinoma. J Clin Oncol. 2006;24(34):5414–8.CrossRefPubMed
29.
Tang LQ, Li CF, Li J, Chen WH, Chen QY, Yuan LX, Lai XP, He Y, Xu YX, Hu DP, et al. Establishment and Validation of Prognostic Nomograms for Endemic Nasopharyngeal Carcinoma. J Natl Cancer Inst. 2016;108(1).
30.
Ong YK, Heng DM, Chung B, Leong SS, Wee J, Fong KW, Tan T, Tan EH. Design of a prognostic index score for metastatic nasopharyngeal carcinoma. Eur J Cancer. 2003;39(11):1535–41.CrossRefPubMed
31.
Chen HH, Chen IH, Liao CT, Wei FC, Lee LY, Huang SF. Preoperative circulating C-reactive protein levels predict pathological aggressiveness in oral squamous cell carcinoma: a retrospective clinical study. Clin Otolaryngol. 2011;36(2):147–53.CrossRefPubMed
32.
Balkwill F, Mantovani A. Cancer and inflammation: implications for pharmacology and therapeutics. Clin Pharmacol Ther. 2010;87(4):401–6.CrossRefPubMed
33.
Allin KH, Nordestgaard BG. Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci. 2011;48(4):155–70.CrossRefPubMed
34.
Liu H, Chen QY, Guo L, Tang LQ, Mo HY, Zhong ZL, Huang PY, Luo DH, Sun R, Guo X, et al. Feasibility and efficacy of chemoradiotherapy for elderly patients with locoregionally advanced nasopharyngeal carcinoma: results from a matched cohort analysis. Radiat Oncol. 2013;8:70.CrossRefPubMedPubMedCentral
Metadata
Title
Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma
Authors
Lin Yang
Liangping Xia
Yan Wang
Shasha He
Haiyang Chen
Shaobo Liang
Peijian Peng
Shaodong Hong
Yong Chen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3630-9

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue

Case report

Dilemmas in a pregnant woman with myelofibrosis secondary to signet ring adenocarcinoma: a case report

Research article

Investigating young women’s motivations to engage in early mammography screening in Switzerland: results of a cross-sectional study

Research article

Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer

Research article

Quantitation of DNA methylation in Epstein-Barr virus–associated nasopharyngeal carcinoma by bisulfite amplicon sequencing

Study protocol

Docetaxel, Cisplatin, and 5-fluorouracil (DCF) chemotherapy in the treatment of metastatic or unresectable locally recurrent anal squamous cell carcinoma: a phase II study of French interdisciplinary GERCOR and FFCD groups (Epitopes-HPV02 study)

Research article

Oligometastases from prostate cancer: local treatment with stereotactic body radiotherapy (SBRT)
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits