Abstract
BACKGROUND: Patients with synchronous metastatic nasopharyngeal carcinoma (smNPC) exhibit significant heterogeneity, and clinical prognostic models suitable for this cohort remain limited. We aimed to develop a prognostic prediction tool to facilitate personalised prognostic assessments and inform treatment decisions for these patients. METHODS: This retrospective multicentre study enrolled 556 patients with smNPC. The training cohort comprised 386 patients from Guangxi Medical University Cancer Hospital, while the external validation cohort comprised 170 patients from Wuzhou Red Cross Hospital and Xiangtan Central Hospital. We applied the Cox proportional hazards model to determine factors associated with overall survival (OS). A nomogram prognostic model was developed to predict OS based on the identified prognostic factors. The model's predictive performance was evaluated for discrimination and calibration, and patients were stratified based on their calculated prognostic risk scores. Kaplan-Meier survival curves were employed to assess prognostic differences across the stratified groups. RESULTS: Multivariate analysis identified that M classification, primary tumour radiotherapy, and immunotherapy were significantly associated with OS. A prognostic nomogram integrating these variables exhibited good discrimination (C-index: 0.743) and calibration, which was validated in an external validation cohort. Patients stratified by the model-derived risk scores into high- and low-risk groups showed a significant difference in survival disparity. CONCLUSIONS: We established a nomogram prognostic model that effectively facilitated individualised prognostic prediction and risk stratification in patients with smNPC, thereby assisting clinicians in treatment decision-making.