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This retrospective study evaluated a three-lineage cytopenia score in 576 patients with locally advanced NPC. The score (0\u20133) was defined as the number of lineages (leukocytes, hemoglobin, platelets) below normal limits. During a median follow-up of 74 months, higher cytopenia grades were significantly associated with worse overall survival, locoregional relapse-free survival, and distant metastasis-free survival (all P\u2009&lt;\u20090.001). The score was an independent prognostic factor. Compared with score 0, score 3 was associated with a 7.55-fold increased risk of death (HR\u2009=\u20097.545, 95%CI: 3.158\u201318.028) and a 21.33-fold increased risk of distant metastasis (HR\u2009=\u200921.333, 95%CI: 5.076\u201389.655). The model incorporating the three-lineage cytopenia score yielded an area under the curve (AUC) of 0.593 (95% CI: 0.533\u20130.652, P\u2009=\u20090.001), indicating modest discriminatory ability. The three-lineage cytopenia score is a simple, independent prognostic indicator for locally advanced NPC with strong predictive value for distant metastasis. It may serve as a useful adjunct to traditional staging for risk stratification.<\/jats:p>","DOI":"10.1371\/journal.pone.0356005","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:29:51Z","timestamp":1786642191000},"page":"e0356005","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of the three-lineage cytopenia score in locally advanced nasopharyngeal carcinoma: A retrospective cohort 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