Abstract
PURPOSE: To explore acute toxicities and prognosis of elderly NPC patients after IMRT; to identify predictors regarding age, chemotherapy, comorbidities, nutrition status, and psychological condition; and to establish a nomogram for the prediction of prognosis. PATIENTS AND METHODS: Elderly NPC patients were divided into three groups (age of 60-65, age of 66-70, and age over 70) and were retrospectively analyzed. The acute toxicities, prognosis, and potential predictors were analyzed. Then, a nomogram for PFS was established, and the performance of nomogram was compared with the performance of TNM system. RESULTS: A total of 214 elderly patients (214/1981, 10.8%) were involved. Patients of Stage III and IV accounted for 73.4%. The 3-year, 5-year PFS and OS were 77.9%, 66.3%, 79.3% and 66.8%, respectively. Elder patients had a worse prognosis (P=0.002). The main cause of death remained in recurrence and metastasis; few died from comorbidities, and some died from nutrition status and psychological condition. Age (HR=1.10, 95% CI=1.05-1.15, P<0.001), ALB level (HR=0.93, 95% CI=0.88-0.99, P=0.019), and T stage (HR=1.85, 95% CI=1.10-3.13, P=0.022) were critical for PFS, but chemotherapy or comorbidities were not. Acute toxicities were mainly at or under grade II. N stage (OR=2.50, 95% CI=1.28-4.88, P=0.007) and chemotherapy (OR=6.01, 95% CI=3.11-11.63, P<0.001) were risk factors for hematological toxicity; while age (OR=0.59, 95% CI=0.37-0.92, P=0.020) and chemotherapy (OR=225.14, 95% CI=61.91-818.64, P<0.001) influenced emesis; ALB (OR=1.11, 95% CI=1.04-1.19, P=0.002) affected mucositis. Comorbidities were not influential in acute toxicities. The nomogram for PFS (C-index=0.682, 95% CI=0.617-0.747) performed better than the TNM system (C-index=0.604, 95% CI=0.532-0.674, P<0.001). CONCLUSION: Elderly NPC patients sustained poor prognosis. The easily applied nomogram is hopeful to benefit the clinical decision-making.