Clinical Research Papers:

A prognostic model combining CD4/CD8 ratio and N stage predicts the risk of distant metastasis for patients with nasopharyngeal carcinoma treated by intensity modulated radiotherapy

Chang-Juan Tao _, Yuan-Yuan Chen, Feng Jiang, Xing-Lai Feng, Qi-Feng Jin, Ting Jin, Yong-Feng Piao and Xiao-Zhong Chen

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Oncotarget. 2016; 7:46653-46661. https://doi.org/10.18632/oncotarget.9695

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Chang-Juan Tao1,*, Yuan-Yuan Chen1,*, Feng Jiang1, Xing-Lai Feng1, Qi-Feng Jin1, Ting Jin1, Yong-Feng Piao1, Xiao-Zhong Chen1

1Department of Radiation Oncology, Zhejiang Cancer Hospital, Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou, Zhejiang Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence to:

Xiao-Zhong Chen, email: [email protected]

Keywords: nasopharyngeal carcinoma, lymphocyte subset, CD4/CD8 ratio, distant metastasis, survival

Received: March 21, 2016     Accepted: April 27, 2016     Published: May 30, 2016


This study aimed to evaluate the correlation between circulating lymphocyte subsets and clinical variables, and design an effective prognostic model for distant metastasis-free survival (DMFS) in NPC. In this study, subsets of circulating lymphocytes were determined in 719 non-metastatic NPC patients before treatment. Overall survival and DMFS was monitored. Significant prognostic factors were identified using univariate and multivariate analyses. Results showed that the percentage of CD19+ lymphocytes correlated negatively with TNM stage (r = –0.082, P = 0.028). Patients with higher CD4/CD8 ratios (≥ 1.77) showed better 5-year DMFS than patients with lower ratios (91.9% vs. 85.4%, P < 0.001). Multivariate analysis revealed that CD4/CD8 ratio (HR, 0.450; 95% confidence interval [CI], 0.266–0.760; P = 0.003) and N classification (HR, 2.294; 95% CI, 1.370–3.839; P = 0.002) were independently prognostic factors for DMFS. The prognostic N-R model was developed and divided patients into three groups: (1) low-risk (early N stage and CD4/CD8 ratio ≥ 1.77); (2) intermediate-risk (advanced N stage or CD4/CD8 ratio < 1.77) and (3) high-risk (advanced N stage and CD4/CD8 ratio < 1.77) of distant metastasis. In conclusion our prognostic model, based on clinical N stage and CD4/CD8 ratio, may predict the risk of distant metastasis, allowing individualized treatment for NPC.

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