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      An inflammatory biomarker‐based nomogram to predict prognosis of patients with nasopharyngeal carcinoma: an analysis of a prospective study

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          Abstract

          Chronic inflammation plays an important role in tumor progression. The aim of this analysis was to evaluate whether inflammatory biomarkers such as the Glasgow prognostic score (GPS), the neutrophil‐lymphocyte ratio (NLR), the platelet‐lymphocyte ratio (PLR), and the lymphocyte‐monocyte ratio (LMR) could predict the prognosis of nasopharyngeal carcinoma (NPC). In this analysis, pretreatment GPS, NLR, PLR, LMR of 388 patients who were diagnosed as nonmetastatic NPC and recruited prospectively in the 863 Program No. 2006AA02Z4B4 were assessed. Of those, the 249 cases enrolled between December 27th 2006 and July 31st 2011 were defined as the development set. The rest 139 cases enrolled between August 1st 2011 and July 31st 2013 were defined as the validation set. The variables above were analyzed in the development set, together with age, gender, Karnofsky performance score, T stage, and N stage, with respect to their impact on the disease‐specific survival (DSS) through a univariate analysis. The candidate prognostic factors then underwent a multivariate analysis. A nomogram was established to predict the DSS, by involving the independent prognostic factors. Its predction capacity was evaluated through calculating Harrell's concordance index (C‐index) in the validation set. After multivariate analysis for the development set, age (≤50 vs. >50 years old), T stage (T1–2 vs. T3–4), N stage (N0–1 vs. N2–3) and pretreatment GPS (0 vs. 1–2), NLR (≤2.5 vs. >2.5), LMR (≤2.35 vs. >2.35) were independent prognostic factors of DSS ( P values were 0.002, 0.008, <0.001, 0.004, 0.018, and 0.004, respectively). A nomogram was established by involving all the factors above. Its C‐index for predicting the DSS of the validation set was 0.734 (standard error 0.056). Pretreatment GPS, NLR, and LMR were independent prognostic factors of NPC. The nomogram based on them could be used to predict the DSS of NPC patients.

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          Most cited references28

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          Myeloid-derived suppressor cells: linking inflammation and cancer.

          Many cancer immunotherapies developed in experimental animals have been tested in clinical trials. Although some have shown modest clinical effects, most have not been effective. Recent studies have identified myeloid-origin cells that are potent suppressors of tumor immunity and therefore a significant impediment to cancer immunotherapy. "Myeloid-derived suppressor cells" (MDSC) accumulate in the blood, lymph nodes, and bone marrow and at tumor sites in most patients and experimental animals with cancer and inhibit both adaptive and innate immunity. MDSC are induced by tumor-secreted and host-secreted factors, many of which are proinflammatory molecules. The induction of MDSC by proinflammatory mediators led to the hypothesis that inflammation promotes the accumulation of MDSC that down-regulate immune surveillance and antitumor immunity, thereby facilitating tumor growth. This article reviews the characterization and suppressive mechanisms used by MDSC to block tumor immunity and describes the mechanisms by which inflammation promotes tumor progression through the induction of MDSC.
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            The prevalence and prevention of nasopharyngeal carcinoma in China

            Nasopharyngeal carcinoma (NPC) has remarkable epidemiological features, including regional, racial, and familial aggregations. The aim of this review is to describe the epidemiological characteristics of NPC and to propose possible causes for the high incidence patterns in southern China. Since the etiology of NPC is not completely understood, approaches to primary prevention of NPC remain under consideration. This situation highlights the need to conduct secondary prevention, including improving rates of early detection, early diagnosis, and early treatment in NPC patients. Since the 1970's, high-risk populations in southern China have been screened extensively for early detection of NPC using anti–Epstein-Barr virus (EBV) serum biomarkers. This review summarizes several large screening studies that have been conducted in the high-incidence areas of China. Screening markers, high-risk age range for screening, time intervals for blood re-examination, and the effectiveness of these screening studies will be discussed. Conduction of prospective randomized controlled screening trials in southern China can be expected to maximize the cost-effectiveness of early NPC detection screening.
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              Epidemiology of nasopharyngeal carcinoma.

              Nasopharyngeal carcinoma (NPC) is a rare malignancy in most parts of the world, with an incidence well under 1 per 100,000 person-years. Exceptions are the Chinese, especially the Cantonese living in the central region of Guangdong Province in Southern China. Other populations with elevated rates include the natives of Southeast Asia, the natives of the Artic region, and the Arabs of North Africa and parts of the Middle East. Intake of preserved foods at an early age has been linked to NPC risk in all population groups with increased NPC rates. Other recognized risk factors for NPC are cigarette smoking, and occupational exposure to formaldehyde and wood dust. Copyright 2002 Elsevier Science Ltd.
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                Author and article information

                Contributors
                xiayf@sysucc.org.cn
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                10 November 2016
                January 2017
                : 6
                : 1 ( doiID: 10.1002/cam4.2017.6.issue-1 )
                : 310-319
                Affiliations
                [ 1 ] Department of Radiation OncologySun Yat‐sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center of Cancer Medicine Guangzhou GuangdongChina
                [ 2 ] Department of OncologyThe 421 Hospital of Chinese People’s Liberation Army Guangzhou GuangdongChina
                [ 3 ] Department of Radiation OncologyAnhui Province Hospital Affiliated to Anhui Medical University Hefei AnhuiChina
                Author notes
                [*] [* ] Correspondence

                Yun‐Fei Xia, Department of Radiation Oncology, Sun Yat‐sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong 510060, China. Tel: +86 136 0280 5461; Fax: +86 20 8734 3392; E‐mail: xiayf@ 123456sysucc.org.cn

                Article
                CAM4947
                10.1002/cam4.947
                5269708
                27860387
                36cc0029-317a-42d8-a81c-3b8e887e8e4d
                © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 July 2016
                : 08 September 2016
                : 26 September 2016
                Page count
                Figures: 3, Tables: 2, Pages: 10, Words: 6515
                Funding
                Funded by: Hi‐Tech Research and Development Program of China
                Award ID: 2006AA02Z4B4
                Categories
                Original Research
                Cancer Prevention
                Original Research
                Custom metadata
                2.0
                cam4947
                January 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.3 mode:remove_FC converted:27.01.2017

                Oncology & Radiotherapy
                disease‐specific survival,inflammatory biomarkers,nasopharyngeal carcinoma,nomogram,prediction

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