Prognostic Value of Pretreatment Serum Cystatin C Level in Nasopharyngeal Carcinoma Patients in the Intensity-modulated Radiotherapy Era
Received 12 October 2020
Accepted for publication 2 December 2020
Published 6 January 2021 Volume 2021:14 Pages 29—37
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Arseniy Yuzhalin
Xi-Rong Tan,* Sheng-Yan Huang,* Sha Gong, Yang Chen, Xiao-Jing Yang, Qing-Mei He, Shi-Wei He, Na Liu, Ying-Qing Li
State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ying-Qing Li; Na Liu
State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People’s Republic of China
Email firstname.lastname@example.org; email@example.com
Purpose: Serum cystatin C has been considered as a significant prognostic factor for various malignancies. This study aimed to evaluate the relationship between serum cystatin C level before antitumor treatment and the prognosis of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).
Patients and Methods: A cohort of 2077 NPC patients were enrolled between April 2009 and September 2012. The Kaplan–Meier curves and log rank tests were used to determine the differences of overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox regression analyses were used to determine independent prognostic factors.
Results: Overall, 362/2077 (17.4%) patients had high serum cystatin C level, and they were older and more male (both P< 0.001), and they had higher TNM stage (all P< 0.05). Kaplan–Meier analysis revealed that patients with high serum cystatin C had worse OS (P< 0.001) and DFS (P< 0.001). Univariate and multivariate Cox regression analysis showed that high serum cystatin C level was an independent prognostic predictor of OS (HR: 1.56, 95%CI: 1.25– 1.95) and DFS (HR: 1.38, 95%CI: 1.13– 1.68). Subgroup analysis based on TNM stage revealed that advanced-stage NPC patients with high serum cystatin C had poorer OS (P< 0.001) and DFS (P< 0.001).
Conclusion: Our results revealed that high serum cystatin C level before antitumor treatment can predict clinical outcomes of NPC patients treated with IMRT, and it can guide clinicians to formulate more personalized therapy for NPC patients.
Keywords: nasopharyngeal carcinoma, serum cystatin C level, survival prognosis, predictor