{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:36:36Z","timestamp":1791822996747,"version":"4.3.4"},"reference-count":30,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2018,3,20]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p> To investigate for a prognostic index (PI) to personalize recommendations for salvage intensity-modulated radiotherapy (IMRT) in patients with locally recurrent nasopharyngeal carcinoma (lrNPC). <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Patients with lrNPC from two academic institutions (Sun Yat-Sen University Cancer Center [SYSUCC-A; n = 251 (training cohort)] and National Cancer Centre Singapore [NCCS; n = 114] and SYSUCC-B [n = 193 (validation cohorts)]) underwent salvage treatment with IMRT from 2001 to 2015. Primary and secondary clinical end points were overall survival (OS) and grade 5 toxicity-free rate (G5-TFR), respectively. Covariate inclusion to the PIs was qualified by a multivariable two-sided P &lt; .05. Discrimination and calibration of the PIs were assessed. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The primary PI comprised covariates that were adversely associated with OS in the training cohort (gross tumor volume<jats:sub>recurrence<\/jats:sub> hazard ratio [HR], 1.01\/mL increase [ P &lt; .001], age<jats:sub>recurrence<\/jats:sub> HR, 1.02\/year increase [ P = .008]; repeat IMRT equivalent dose in 2-Gy fractions [EQD2] \u2265 68 Gy HR, 1.42 [ P = .03]; prior radiotherapy-induced grade \u2265 3 toxicities HR, 1.90 [ P = .001]; recurrent tumor [rT]-category 3 to 4 HR, 1.96 [ P = .005]), in ascending order of weight. Discrimination of the PI for OS was comparable between training and both validation cohorts (Harrell\u2019s C = 0.71 [SYSUCC-A], 0.72 [NCCS], and 0.69 [SYSUCC-B]); discretization by using a fixed PI score cutoff of 252 determined from the training data set yielded low- and high-risk subgroups with disparate OS in the validation cohorts (NCCS HR, 3.09 [95% CI, 1.95 to 4.89]; SYSUCC-B HR, 3.80 [95% CI, 2.55 to 5.66]). Our five-factor PI predicted OS and G5-TFR (predicted v observed 36-month OS and G5-TFR, 22% v 15% and 38% v 44% for high-risk NCCS and 26% v 31% and 45% v 46% for high-risk SYSUCC-B). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> We present a validated PI for robust clinical stratification of radioresistant NPC. Low-risk patients represent ideal candidates for curative repeat IMRT, whereas novel clinical trials are needed in the unfavorable high-risk subgroup. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.2017.75.5165","type":"journal-article","created":{"date-parts":[[2018,2,7]],"date-time":"2018-02-07T20:59:38Z","timestamp":1518037178000},"page":"891-899","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":110,"title":["Prognostic Model for Stratification of Radioresistant Nasopharynx Carcinoma to Curative Salvage Radiotherapy"],"prefix":"10.1200","volume":"36","author":[{"given":"You Quan","family":"Li","sequence":"first","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Ming","family":"Tian","sequence":"additional","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze Huey","family":"Tan","sequence":"additional","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming Zhu","family":"Liu","sequence":"additional","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Kusumawidjaja","sequence":"additional","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enya H.W.","family":"Ong","sequence":"additional","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, Duke-National University of Singapore Medical School, Singapore; Yun Ming Tian, Huizhou Municipal Central Hospital, Huizhou; and Ming Zhu Liu, Chong Zhao, and Fei Han, Collaborative Innovation Center for Cancer Medicine..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Zhao","sequence":"additional","affiliation":[{"name":"You Quan Li, Sze Huey Tan, Grace Kusumawidjaja, Enya H.W. Ong, Terence W.K. Tan, Kam Weng Fong, Kiattisa Sommat, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. Chua, National Cancer Centre Singapore; Terence W.K. Tan, Kam Weng Fong, Yoke Lim Soong, Joseph T.S. Wee, and Melvin L.K. 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