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已发表论文
与验证的一项基于中性粒细胞百分比/白蛋白比值的列线图用于预测总生存期在局部晚期鼻咽癌开发
Received 26 September 2025
Accepted for publication 26 January 2026
Published 5 February 2026 Volume 2026:19 566289
DOI https://doi.org/10.2147/JIR.S566289
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Subhasis Chattopadhyay
Xiaohui Yang,1 Lu Huang,2 Song Qu1
1Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China; 2Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
Correspondence: Song Qu, Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530200, People’s Republic of China, Tel +86 13607887386, Email 13607887386@163.com
Purpose: Hematology-based inflammatory-nutritional composite indices are robust prognostic biomarkers for malignancies due to their survival correlation. This study explored the prognostic value of the neutrophil percentage-albumin ratio (NPAR) – a composite marker reflecting systemic inflammation and nutrition – in locally advanced nasopharyngeal carcinoma (LA-NPC), whose predictive role in LA-NPC survival remains underexplored.
Patients and Methods: A retrospective study of 536 LA-NPC patients who received definitive radiotherapy at Guangxi Medical University Cancer Hospital was conducted. Patients were randomized into training (n=321, 60%) and validation (n=215, 40%) cohorts via the `sample()` function in R. NPAR and other continuous variables were dichotomized using optimal cut-offs from the `survminer` package in R. Kaplan-Meier and Log-rank analyses compared survival; least absolute shrinkage and selection operator (LASSO) regression identified key prognostic parameters, with univariate and multivariate Cox regression confirming independent survival factors. A prognostic nomogram was built from these factors, and its predictive efficacy was evaluated via calibration curves (accuracy), Harrell’s C-index (discrimination), time-dependent receiver operating characteristic (tROC) curves, and decision curve analysis (DCA; clinical utility).
Results: Multivariate Cox regression for overall survival (OS) in the training cohort identified NPAR, age, TNM stage, pretreatment EBV DNA level, and hypertension as independent prognostic factors for LA-NPC. A nomogram integrating these five variables was constructed. Calibration curves, C-index, tROC curves, and DCA confirmed that the nomogram accurately predicted 3- and 5-year OS probabilities, with high consistency between predicted and observed outcomes. Furthermore, the nomogram outperformed the 8th edition TNM staging system in terms of predictive performance, as evidenced by superior C-index, tROC, and DCA results.
Conclusion: NPAR, an accessible routine blood-based hematological biomarker, is a promising prognostic indicator for LA-NPC. The nomogram integrating NPAR and key clinical parameters enables more accurate personalized treatment stratification, facilitating precision management and yielding translational potential for improved LA-NPC outcomes.
Keywords: NPAR, locally advanced nasopharyngeal carcinoma, prognostic nomogram
1Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China; 2Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
Correspondence: Song Qu, Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530200, People’s Republic of China, Tel +86 13607887386, Email 13607887386@163.com
Purpose: Hematology-based inflammatory-nutritional composite indices are robust prognostic biomarkers for malignancies due to their survival correlation. This study explored the prognostic value of the neutrophil percentage-albumin ratio (NPAR) – a composite marker reflecting systemic inflammation and nutrition – in locally advanced nasopharyngeal carcinoma (LA-NPC), whose predictive role in LA-NPC survival remains underexplored.
Patients and Methods: A retrospective study of 536 LA-NPC patients who received definitive radiotherapy at Guangxi Medical University Cancer Hospital was conducted. Patients were randomized into training (n=321, 60%) and validation (n=215, 40%) cohorts via the `sample()` function in R. NPAR and other continuous variables were dichotomized using optimal cut-offs from the `survminer` package in R. Kaplan-Meier and Log-rank analyses compared survival; least absolute shrinkage and selection operator (LASSO) regression identified key prognostic parameters, with univariate and multivariate Cox regression confirming independent survival factors. A prognostic nomogram was built from these factors, and its predictive efficacy was evaluated via calibration curves (accuracy), Harrell’s C-index (discrimination), time-dependent receiver operating characteristic (tROC) curves, and decision curve analysis (DCA; clinical utility).
Results: Multivariate Cox regression for overall survival (OS) in the training cohort identified NPAR, age, TNM stage, pretreatment EBV DNA level, and hypertension as independent prognostic factors for LA-NPC. A nomogram integrating these five variables was constructed. Calibration curves, C-index, tROC curves, and DCA confirmed that the nomogram accurately predicted 3- and 5-year OS probabilities, with high consistency between predicted and observed outcomes. Furthermore, the nomogram outperformed the 8th edition TNM staging system in terms of predictive performance, as evidenced by superior C-index, tROC, and DCA results.
Conclusion: NPAR, an accessible routine blood-based hematological biomarker, is a promising prognostic indicator for LA-NPC. The nomogram integrating NPAR and key clinical parameters enables more accurate personalized treatment stratification, facilitating precision management and yielding translational potential for improved LA-NPC outcomes.
Keywords: NPAR, locally advanced nasopharyngeal carcinoma, prognostic nomogram