Ferritin as a novel predictive index for nasopharyngeal carcinoma survival and therapeutic efficacy of different chemotherapy regimens

Abstract

BACKGROUND

In the treatment of nasopharyngeal carcinoma (NPC), there is a lack of effective assessment of the long-term effects on patients. Searching for an effective evaluation scheme and screening a reliable index for various therapeutic regimens is an urgent clinical issue that needs to be resolved.

AIM

To establish an effective evaluation scheme and screen a reliable index for NPC patients across various therapeutic regimens.

METHODS

This population-based retrospective cohort study included NPC survivors (n = 1142; weighted population, 100984) from the OB database of the Hunan Cancer Hospital, spanning from 2011 to 2023. The software DT Health (V 6.8) and I Medical software were utilized to extract the data. By leveraging the aforementioned database, the survival and mortality rates of NPC patients across various therapeutic regimens were analyzed. Three Cox regression models were formulated to explore the independent association of the Ferritin index with 3- and 5-year mortality risk. We used restricted cubic spline analysis to assess the potential nonlinear relationships between Ferritin-related indices and 3- and 5-year mortality. We also assessed the association between the Ferritin index and mortality using Cox proportional hazards regression models. All NPC patients were randomly divided into training and validation sets in a 3:7 ratio. Receiver operating characteristic (ROC), decision curve analysis (DCA), and calibration curves were plotted simultaneously for both training and validation sets.

RESULTS

NPC patients were divided into two groups: Survivors (615, 53.85%) and non-survivors (527, 46.15%) based on their 5-year mortality. The 5-year mortality rate of males (71.35%) was higher than that of females (28.65%). The tumor stage of the non-survivors converged to TNM stages III and IV. Non-survivors displayed significantly higher levels of Ferritin, lactate dehydrogenase, and carcinoembryonic antigen than the survivors (P < 0.05). Follow-up analysis revealed that nidaplatin plus 5-fluorouracil (NF), docetaxel plus nidaplatin (TN), and docetaxel plus cisplatin (TP) regimens were associated with imporved 5-year survival in NPC patients. The 3- and 5-year rates showed a significant association with Ferritin level. When patients were stratified by Ferritin index quartiles, the tumor stages were predominantly skewed towards TNM stages III and IVa. Thus, Ferritin serves as a key novel biomarker for assessing NPC treatment efficacy. The Ferritin index was significantly associated with 3- and 5-year mortality risk. This correlation was evident in both the unadjusted and fully adjusted models. There was a minor level, S-shaped correlation between the Ferritin index and 3-year mortality. NPC patients with the Ferritin index in quartiles 1 and 3 had a higher 5-year mortality risk. Kaplan-Meier curves demonstrated that there were significant differences in mortality rates among different Ferritin quartiles. NPC patients with the Ferritin index in quartile 4 exhibited the highest 5-year survival rates. ROC curve analysis based on logistic regression predictive model revealed that the Ferritin index predicted 5-year mortality in the validation set. Additionally, the DCA curves of both the training and validation sets indicated that the Ferritin index optimized the predictive performance of the basic risk model for 5-year mortality.

CONCLUSION

The chemotherapy regimens of NF, TN, and TP for NPC are associated with the prognosis of NPC. The Ferritin index is an important indicator for predicting NPC survival.

Keywords: Nasopharyngeal carcinoma; Ferritin; Retrospective study; Survival indicators; Predictive model; Restricted cubic spline; Receiver operating characteristic curves; Decision curve analysis curves

Core Tip: In this study, a large-sample analysis of nasopharyngeal carcinoma (NPC) patients showed that chemotherapy regimens can improve the survival rate and prognosis of NPC patients. The Ferritin index is the most significant indicator for distinguishing NPC patients. Cox regression and receiver operating characteristic curve analysis, supported by decision curve analysis across training and validation sets, demonstrated that the Ferritin index significantly enhanced the predictive ability of the basic risk model for 5-year mortality. These findings support the development of a novel Ferritin-based biomarker for the diagnosis and prognosis of NPC.