# Prognostic Value of Pre‐Treatment Diffusion Kurtosis Imaging for Progression‐Free Survival Prediction in Advanced Nasopharyngeal Carcinoma

## TL;DR

This study shows that pretreatment diffusion kurtosis imaging can help predict long-term survival in patients with advanced nasopharyngeal carcinoma.

## Contribution

The study demonstrates that mean kurtosis from DKI is a novel noninvasive biomarker for predicting progression-free survival in NPC.

## Key findings

- Pretreatment mean kurtosis (MK) is an independent prognostic factor for progression-free survival (PFS) in NPC.
- A nomogram combining MK, clinical stage, and neoadjuvant chemotherapy improves PFS prediction accuracy.
- Higher MK values correlate with better survival outcomes in NPC patients.

## Abstract

This study aimed to evaluate the value of diffusion kurtosis imaging (DKI) for prognostic value for long‐term PFS in nasopharyngeal carcinoma (NPC).

A cohort of 295 NPC patients underwent pretreatment 3.0T MRI with DKI to derive mean kurtosis (MK), mean diffusion (MD), and apparent diffusion coefficient (ADC). Clinical parameters (Tumor stage, EBV‐DNA, neoadjuvant chemotherapy regimens) were recorded. Follow‐up extended to December 2023. Statistical analyses (R software v4.3.0) included univariate/multivariate Cox regression and Kaplan–Meier survival analysis. A prognostic nomogram integrating key predictors was developed.

Median 10‐year follow‐up revealed 2‐, 5‐, and 10‐year PFS rates of 89%, 79%, and 74%, respectively. Univariate Cox regression analysis demonstrated that T stage, Clinical Stages, NAC regimens, ADC_Group, MK_Group, and MD_Group were significant prognostic factors for PFS in NPC (p < 0.05). Multivariate analysis identified Clinical Stage (HR = 2.230, 95% CI 1.44–3.66, p < 0.001), NAC (neoadjuvant chemotherapy) regimens (HR = 0.56, 95% CI 0.35–0.90, p = 0.017), and MK_Group (HR = 0.52, 95% CI 0.33–0.82, p = 0.003) as independent prognostic factors. The MK_Group high exhibited superior survival rates versus MK_Group low (2‐year: 94% vs. 81%; 5‐year: 85% vs. 66%; 10‐year: 79% vs. 64%; all p < 0.05). The nomogram combining Clinical Stage, NAC, and MK_Group demonstrated moderate predictive accuracy for 2‐, 5‐, and 10‐year PFS (AUC = 0.736, 0.718, 0.697).

Pretreatment MK serves as a robust noninvasive biomarker for long‐term PFS in NPC. Integration with Clinical Stage and NAC regimens enhances prognostic stratification, supporting personalized therapeutic strategies.