# A low-cost bedside nomogram integrating TSF and pain for predicting severe malnutrition in nasopharyngeal carcinoma: a prospective cohort study

## TL;DR

Researchers developed a low-cost tool to predict severe malnutrition in nasopharyngeal cancer patients using skinfold thickness and pain scores, helping guide early treatment.

## Contribution

A novel, low-cost bedside nomogram integrating NRS 2002, TSF, and Pain scores for predicting severe malnutrition in NPC patients.

## Key findings

- NRS 2002 score, Pain score, and TSF were identified as independent predictors of severe malnutrition.
- The nomogram showed strong discrimination with an AUC of 0.903 in the training set and 0.825 in validation.
- The tool enables immediate risk stratification without blood tests, suitable for resource-limited settings.

## Abstract

To examine the relationship between nutritional status and quality of life (QoL) in hospitalized patients with nasopharyngeal carcinoma (NPC), identify independent predictors of severe malnutrition, and establish a practical “low-cost” predictive nomogram to guide early clinical intervention.

This study is a secondary analysis of a prospective cohort from the Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) project. We included 216 NPC patients prospectively enrolled at a participating center between January 2014 and December 2019. Clinical data, anthropometrics (including Triceps Skinfold Thickness, TSF), and patient-reported outcomes (NRS 2002 and pain scores) were collected upon admission. Patients were randomly split into a training cohort (n = 152) and an internal validation cohort (n = 64) at a 7:3 ratio. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), with severe malnutrition defined as a PG-SGA score ≥ 9. Logistic regression was performed to develop the nomogram.

Among the 216 patients (77.8% male; mean age 50.5 ± 10.6 years), 26.9% were at nutritional risk (NRS 2002 ≥ 3), and 23.2% suffered from severe malnutrition. Worsening nutritional status was significantly associated with lower functional domain scores and higher symptom burden in QoL (p < 0.05). Multivariate logistic regression identified NRS 2002 score (OR = 28.52, p < 0.001), Pain score (OR = 2.81, p = 0.014), and TSF (OR = 0.83, p = 0.004) as independent predictors. The nomogram demonstrated strong discrimination, with an AUC of 0.903 in the training set and 0.825 in the internal validation set. Calibration curves and decision curve analysis (DCA) confirmed the model’s clinical utility.

Based on the prospective INSCOC dataset, we developed and validated a novel, low-cost bedside nomogram integrating NRS 2002, TSF, and Pain scores. By bypassing the need for blood tests, this tool enables immediate risk stratification for NPC patients, particularly in resource-limited settings, facilitating timely and personalized nutritional interventions.

Infographic summarizing the development and validation of a low-cost predictive nomogram for nutritional status and quality of life in hospitalized nasopharyngeal carcinoma patients, featuring graphics depicting patient assessment criteria, nutrition progression, quality of life impact bar charts, nomogram construction, methodology, key statistics, and clinical applicability including use in resource-limited settings without need for blood tests.