Prognostic Value of Pretreatment Serum Cystatin C Level in Nasopharyngeal Carcinoma Patients in the Intensity-modulated Radiotherapy Era

Xi-Rong Tan; Sheng-Yan Huang; Sha Gong; Yang Chen; Xiao-Jing Yang; Qing-Mei He; Shi-Wei He; Na Liu; Ying-Qing Li

doi:10.2147/OTT.S286009

Prognostic Value of Pretreatment Serum Cystatin C Level in Nasopharyngeal Carcinoma Patients in the Intensity-modulated Radiotherapy Era

Onco Targets Ther. 2021 Jan 6:14:29-37. doi: 10.2147/OTT.S286009. eCollection 2021.

Authors

Xi-Rong Tan^#¹, Sheng-Yan Huang^#¹, Sha Gong¹, Yang Chen¹, Xiao-Jing Yang¹, Qing-Mei He¹, Shi-Wei He¹, Na Liu¹, Ying-Qing Li¹

Affiliation

¹ State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Serum cystatin C has been considered as a significant prognostic factor for various malignancies. This study aimed to evaluate the relationship between serum cystatin C level before antitumor treatment and the prognosis of nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).

Patients and methods: A cohort of 2077 NPC patients were enrolled between April 2009 and September 2012. The Kaplan-Meier curves and log rank tests were used to determine the differences of overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox regression analyses were used to determine independent prognostic factors.

Results: Overall, 362/2077 (17.4%) patients had high serum cystatin C level, and they were older and more male (both P<0.001), and they had higher TNM stage (all P<0.05). Kaplan-Meier analysis revealed that patients with high serum cystatin C had worse OS (P<0.001) and DFS (P<0.001). Univariate and multivariate Cox regression analysis showed that high serum cystatin C level was an independent prognostic predictor of OS (HR: 1.56, 95%CI: 1.25-1.95) and DFS (HR: 1.38, 95%CI: 1.13-1.68). Subgroup analysis based on TNM stage revealed that advanced-stage NPC patients with high serum cystatin C had poorer OS (P<0.001) and DFS (P<0.001).

Conclusion: Our results revealed that high serum cystatin C level before antitumor treatment can predict clinical outcomes of NPC patients treated with IMRT, and it can guide clinicians to formulate more personalized therapy for NPC patients.

Keywords: nasopharyngeal carcinoma; predictor; serum cystatin C level; survival prognosis.

Grants and funding

This work was supported by grants from the Natural Science Foundation of Guangdong Province (No. 2018B030306045), and the Guangdong Special Support Program (No. 2017TQ04R754).