Abstract
Background
Images from magnetic resonance imaging (MRI) are crucial unstructured data for prognostic evaluation in nasopharyngeal carcinoma (NPC). We developed and validated a prognostic ...system based on the MRI features and clinical data of locoregionally advanced NPC (LA-NPC) patients to distinguish low-risk patients with LA-NPC for whom concurrent chemoradiotherapy (CCRT) is sufficient.
Methods
This multicenter, retrospective study included 3444 patients with LA-NPC from January 1, 2010, to January 31, 2017. A 3-dimensional convolutional neural network was used to learn the image features from pretreatment MRI images. An eXtreme Gradient Boosting model was trained with the MRI features and clinical data to assign an overall score to each patient. Comprehensive evaluations were implemented to assess the performance of the predictive system. We applied the overall score to distinguish high-risk patients from low-risk patients. The clinical benefit of induction chemotherapy (IC) was analyzed in each risk group by survival curves.
Results
We constructed a prognostic system displaying a concordance index of 0.776 (95% confidence interval CI = 0.746 to 0.806) for the internal validation cohort and 0.757 (95% CI = 0.695 to 0.819), 0.719 (95% CI = 0.650 to 0.789), and 0.746 (95% CI = 0.699 to 0.793) for the 3 external validation cohorts, which presented a statistically significant improvement compared with the conventional TNM staging system. In the high-risk group, patients who received induction chemotherapy plus CCRT had better outcomes than patients who received CCRT alone, whereas there was no statistically significant difference in the low-risk group.
Conclusions
The proposed framework can capture more complex and heterogeneous information to predict the prognosis of patients with LA-NPC and potentially contribute to clinical decision making.
This study aims to evaluate the value of a serum metabolomics-based metabolic signature for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) patients, thereby assisting clinical decisions.
...In this retrospective study, a total of 320 LA-NPC patients were randomly divided into a training set (ca. 70%;
= 224) and a validation set (ca. 30%;
= 96). Serum samples were analyzed using widely targeted metabolomics. Univariate and multivariate Cox regression analyses were used to identify candidate metabolites related to progression-free survival (PFS). Patients were categorized into high-risk and low-risk groups based on the median metabolic risk score (Met score), and the PFS difference between the two groups was compared using Kaplan-Meier curves. The predictive performance of the metabolic signature was evaluated using the concordance index (C-index) and the time-dependent receiver operating characteristic (ROC), and a comprehensive nomogram was constructed using the Met score and other clinical factors.
Nine metabolites were screened to build the metabolic signature and generate the Met score, which effectively separated patients into low- and high-risk groups. The C-index in the training and validation sets was 0.71 and 0.73, respectively. The 5-year PFS was 53.7% (95% CI, 45.12-63.86) in the high-risk group and 83.0% (95%CI, 76.31-90.26) in the low-risk group. During the construction of the nomogram, Met score, clinical stage, pre-treatment EBV DNA level, and gender were identified as independent prognostic factors for PFS. The predictive performance of the comprehensive model was better than that of the traditional model.
The metabolic signature developed through serum metabolomics is a reliable prognostic indicator of PFS in LA-NPC patients and has important clinical significance.
Two cycles of induction chemotherapy (IC) followed by 2 cycles of platinum-based concurrent chemoradiotherapy (CCRT) (2IC+2CCRT) for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) is ...widely adopted but not evidence-confirmed. This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy, toxicity and cost-effectiveness.
This real-world study from two epidemic centers used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. The enrolled patients were divided into three groups based on treatment modality: Group A (2IC+2CCRT), Group B (3IC+2CCRT or 2IC+3CCRT) and Group C (3IC+3CCRT). Long-term survival, acute toxicities and cost-effectiveness were compared among the groups. We developed a prognostic model dividing the population into high- and low-risk cohorts, and survivals including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS) were compared among the three groups according to certain risk stratifications.
Of 4,042 patients, 1,175 were enrolled, with 660, 419, and 96 included in Groups A, B and C, respectively. Five-year survivals were similar among the three groups after PSM and confirmed by IPTW. Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A (52.1%
41.5%
25.2%; 41.7%
32.7%
25.0%) as were grade 3-4 nausea/vomiting and oral mucositis (29.2%
15.0%
6.1%; 32.3%
25.3%
18.0%). Cost-effective analysis suggested that 2IC+2CCRT was the least expensive, while the health benefits were similar to those of the other groups. Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients, while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals, mainly reflected by LRRFS.
In LA-NPC patients, 2IC+2CCRT was the optimal choice regarding efficacy, toxicity and cost-effectiveness; however, 2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high- and low-risk populations, respectively.
Purpose
To evaluate the prognostic effect of pretreatment serum superoxide dismutase (SOD) activity in locoregionally advanced nasopharyngeal carcinoma.
Methods
A total of 498 patients diagnosed with ...stage III–IVA nasopharyngeal carcinoma between January 2013 and December 2016 were involved in this study. The X-tile program was used to determine the cut-off value of pretreatment serum SOD activity based on disease-free survival. Kaplan–Meier methods and Cox proportional hazards models were used to evaluate the impact of serum SOD levels on survival outcomes. The receiver operating characteristic (ROC) curve analysis was used to compare the prognostic value of clinical stage, pretreatment serum SOD level, and the combination of them regarding disease-free survival.
Results
Based on the X-tile plot, the optimal cutoff value of pretreatment serum SOD activity for disease-free survival was 146.0U/mL. As a dichotomous variable, SOD was significantly higher in non-keratinizing differentiated disease (P = 0.027) and early T stage (P = 0.011). Compared with the lower subset, higher SOD activity predicted an inferior 3-year rates of overall survival (84.6 vs. 94.7%, P < 0.001), distant metastasis-free survival (78.3 vs. 92.8%, P < 0.001) and disease-free survival (78.2 vs. 92.8%, P < 0.001). Multivariate analysis verified that the SOD activity was an independent prognostic indicator to predict distant metastasis, disease progression, and death. The area under the ROC curve (AUC) of the combination was superior to that of clinical stage or SOD alone for disease-free survival (both P < 0.01).
Conclusion
Serological SOD activity before treatment is an important prognostic indicator for patients with stage III–IV non-metastatic nasopharyngeal carcinoma undergoing chemoradiation therapy.
Surface-enhanced Raman spectroscopy (SERS) is widely used as a detection method in scientific research fields. However, the method for creating SERS substrates often requires expensive equipment and ...involves a complex process. Additionally, preserving and effectively utilizing SERS substrates in the long term poses a challenging problem. In order to address these issues, we propose a new method for creating SERS substrates on various types of paper using a combination of a ballpoint pen and 3D printing. This method ensures a high enhancement factor and maximizes the utilization of the substrate. We achieved an enhancement factor of up to 8.2 × 108 for detecting R6G molecules, with a relative standard deviation of 11.13% for the Raman peak at 612 cm−1 of R6G, demonstrating excellent SERS sensitivity and spectral reproducibility. Furthermore, we successfully detected thiram at a concentration as low as 10−8, which is lower than both the Chinese national standard and European standard.
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