# Development and validation of a practical score to predict 3-year distant metastatic free survival in nasopharyngeal carcinoma incorporating the number of lymph node regions

## TL;DR

This study created a simple scoring system to predict distant metastasis risk in nasopharyngeal cancer patients over three years.

## Contribution

A novel practical score incorporating lymph node regions and other factors to predict distant metastasis in NPC.

## Key findings

- The model achieved a C-index of 0.79 for predicting distant metastatic free survival.
- Patients were categorized into low-risk (96% 3-year DMFS) and high-risk (64.5% 3-year DMFS) groups based on the score.

## Abstract

The improvement in diagnosis and treatment for nasopharyngeal carcinoma (NPC) has shifted the pattern of failure toward distant metastasis. This study aimed to develop a simplified prognostic scoring model to predict distant metastatic free survival (DMFS) for NPC patients.

Patients with non-metastatic NPC were identified from a retrospective cohort diagnosed between 2010 and 2018. Flexible parametric survival analysis was used to identify potential predictors for DMFS and establish a scoring model. The prognostic accuracy between the 8th AJCC system and the scoring model was compared using Harrell’s C-index.

Of the total 393 patients, the median follow-up time was 85 months. The 3-year DMFS rate was 83.3%. Gender, T-stage, pre-EBV (cut-off 2300 copies/ml), and the number of metastatic lymph node regions were identified as independent risk factors for distant metastasis and were included in the final scoring model. Our established model achieved a high C-index in predicting DMFS (0.79) and was well-calibrated. The score divided patients into two categories: low-risk (score 0–4) and high-risk (score 5–7), corresponding with the predicted 3-year DMFS of 96% and 64.5%, respectively.

A feasible and applicative prognostic score was established and validated to discriminate NPC patients into low- and high-risk groups.