Prognostic significance of immune-inflammatory and nutritional indicators in locoregionally advanced nasopharyngeal carcinoma.

OBJECTIVE: This investigation was conducted to evaluate the prognostic relevance of immune-inflammatory and nutritional biomarkers in patients diagnosed with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). METHODS: This retrospective analysis included 267 patients. We utilized principal component analysis (PCA) for dimensionality reduction. The estimation of survival outcomes relied on Kaplan-Meier curve analysis. Multivariate Cox regression was performed to pinpoint independent prognostic factors, which facilitated the subsequent development of a nomogram. The predictive accuracy of the nomogram was evaluated using calibration curves alongside decision curve analysis (DCA). Internal validation was performed using the bootstrap resampling method with 1,000 iterations. RESULTS: PCA yielded two major components, including C1 (immune-inflammatory index) and C2 (nutritional index). The cut-off value of C2 was -0.242. Patients with high C2 (≥ -0.242) exhibited significantly better survival than those with a low C2 (< -0.242). Multivariate analysis confirmed age, T stage, lactate dehydrogenase level, and C2 as independent predictors. The resulting nomogram demonstrated strong predictive accuracy, with a concordance index (C-index) of 0.738, and was well-calibrated. DCA indicated a greater net clinical benefit compared to conventional treatment strategies. The bias-corrected C-index was 0.7177 using the bootstrap resampling method. Using the nomogram's risk score, patients were divided into low- and high-risk groups, with the low-risk group showing significantly superior survival. High-risk patients receiving induction chemotherapy before radiotherapy or concurrent chemoradiotherapy (RT/CCRT) experienced significantly greater gains in overall survival and locoregional relapse-free survival than RT/CCRT alone. By contrast, for low-risk individuals, equivalent efficacy was observed following either treatment approach. CONCLUSION: The C2 represents a reliable prognostic marker in LA-NPC. The developed nomogram enables personalized risk evaluation and aids in clinical decisions regarding tailored therapeutic approaches.