Prognostic Biomarkers in Nasopharyngeal Carcinoma

From January 2004 to December 2012, newly identified NPC patients who enrolled in the Third Affiliated Hospital of Soochow University were studied. The inclusion criteria were: (1) NPC was confirmed by histopathology, (2) Karnofsky performance score (KPS)≥70, (3) patient had detailed medical records, including MRT, CT, and bone scan for staging, (4) patients received radiotherapy for the first time, (5) patients had measurement of neutrophil, platelet, lymphocyte and monocyte at the same time within 1 weeks before therapy. The exclusion criteria were: (1) distant metastases before or during radiotherapy, (2) radiotherapy uncompleted, (3) any severe coexisting disease mainly including severe dysfunction of heart, lung, liver, or kidney, (4) signs of infection such as acute pancreatitis, cholangitis, or other active concomitant infections. At last, 327 patients were enrolled in this study. This study was undertaken according to the Declaration of Helsinki and was approved by the Ethics Committee of Third Affiliated Hospital of Soochow University. Written informed consent was obtained from all patients.
327 patients were treated with continuously definitive radiotherapy with daily fractions of 2.0 Gy and five fractions per week by 6-8 MV x-ray. Among them, 198 patients with NPC were treated with 2-dimensional radiotherapy (2DRT), and 129 were treated with intensity-modulated radiotherapy (IMRT). The primary tumor was given a total dose of 60–78 Gy in 2DRT. In IMRT, the radiation dose-ranges to the nasopharynx, lymph node-positive area and lymph node-negative area were 60–80, 60–70 and 50–56 Gy, respectively. The regimen of inductive chemotherapy was one or two cycles of paclitaxel (135 mg/m²) and nedaplatin (80 mg/m²) every 3 weeks. Two to three cycles of nedaplatin (80mg/m²) every 3 weeks were used in concurrent chemoradiotherapy. A total of 259 (79.2%) patients received chemotherapy, with 36 patients treated with inductive chemotherapy only, 69 patients treated with concurrent chemotherapy and 154 patients treated with inductive chemotherapy plus concurrent chemotherapy.
All peripheral blood was collected and tested for neutrophils, lymphocytes, platelet, and monocyte counts within 1 weeks before therapy. The definitions of SII, PLR, NLR and MLR are described as follows: SII= platelet*neutrophil/lymphocyte; PLR= platelet/lymphocyte; NLR= neutrophil/lymphocyte; MLR= monocyte/lymphocyte. The optimal cutoff values including SII (SII≤403, SII>403), NLR (NLR≤2.26, NLR>2.26), PLR (PLR≤112, PLR>112) and MLR (MLR≤0.25, MLR>0.25) were determined by using X-tile software (http://www.tissuearray.org/rimmlab) [34 (link)].