A pretreatment TNM-metabolic vulnerability score with EBV DNA adjustment for risk stratification in non-metastatic nasopharyngeal carcinoma
4 affiliations
- 1Department of Oncology, The First Affiliated Hospital of Gannan Medical University
- 2The First Clinical Medical College, Gannan Medical University
- 3Department of Oncology, Ma’anshan 17th Metallurgical Hospital
- 4Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Gannan Medical University
Abstract
Background: TNM stage and pretreatment plasma Epstein-Barr virus (EBV) DNA are central to risk assessment in nasopharyngeal carcinoma (NPC), but they do not fully capture host metabolic reserve.
Methods: We retrospectively analyzed 160 patients with non-metastatic NPC treated from 2013 to 2022. The integrated metabolic vulnerability score (IMVS; range, 0-3) assigned 1 point each for stage IVA, triglyceride-to-HDL cholesterol ratio <1.217, and body mass index <23.79 kg/m2. Cox regression and bootstrap internal validation evaluated progression-free survival (PFS), with EBV DNA included as an adjustment variable. A broader 271-patient cohort from the same institution was used only for internal sensitivity analysis.
Results: Thirty-three PFS events occurred in the modeling cohort. Five-year PFS was 100.0%, 91.9%, 72.1%, and 50.0% for IMVS scores 0, 1, 2, and 3, respectively. IMVS remained associated with PFS after adjustment for EBV DNA status (HR, 2.74; bootstrap percentile 95% CI, 1.89-4.75; P<0.001), although EBV DNA status itself was not independently significant in this cohort. The optimism-corrected AUC was 0.715 for stage IVA, THR, and BMI and 0.727 after adding EBV DNA. In the broader same-institution cohort, the association persisted but was attenuated (HR, 1.55; 95% CI, 1.14-2.10; P = 0.005).
Conclusion: IMVS is an exploratory, low-cost risk-stratification tool that may complement, rather than replace, TNM stage and plasma EBV DNA. Prospective external validation and recalibration of the data-derived thresholds are required before clinical use.
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BibTeX
@article{zhong2026pretreatment,
title = {{A pretreatment TNM-metabolic vulnerability score with EBV DNA adjustment for risk stratification in non-metastatic nasopharyngeal carcinoma}},
author = {Jinghua Zhong and Chunyan Zhou and Qiang Yi and Kui Zhong and Zheng Chen and Xinting Ouyang and Changyong Xu and Jiahua Liao and Weifeng Chen and Xiaojun Zhang},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1914286},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1914286/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - A pretreatment TNM-metabolic vulnerability score with EBV DNA adjustment for risk stratification in non-metastatic nasopharyngeal carcinoma
AU - Jinghua Zhong
AU - Chunyan Zhou
AU - Qiang Yi
AU - Kui Zhong
AU - Zheng Chen
AU - Xinting Ouyang
AU - Changyong Xu
AU - Jiahua Liao
AU - Weifeng Chen
AU - Xiaojun Zhang
PY - 2026
DA - 2026/10/30
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1914286
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1914286/full
AB - Background: TNM stage and pretreatment plasma Epstein-Barr virus (EBV) DNA are central to risk assessment in nasopharyngeal carcinoma (NPC), but they do not fully capture host metabolic reserve. Methods: We retrospectively analyzed 160 patients with non-metastatic NPC treated from 2013 to 2022. The integrated metabolic vulnerability score (IMVS; range, 0-3) assigned 1 point each for stage IVA, triglyceride-to-HDL cholesterol ratio <1.217, and body mass index <23.79 kg/m2. Cox regression and bootstrap internal validation evaluated progression-free survival (PFS), with EBV DNA included as an adjustment variable. A broader 271-patient cohort from the same institution was used only for internal sensitivity analysis. Results: Thirty-three PFS events occurred in the modeling cohort. Five-year PFS was 100.0%, 91.9%, 72.1%, and 50.0% for IMVS scores 0, 1, 2, and 3, respectively. IMVS remained associated with PFS after adjustment for EBV DNA status (HR, 2.74; bootstrap percentile 95% CI, 1.89-4.75; P<0.001), although EBV DNA status itself was not independently significant in this cohort. The optimism-corrected AUC was 0.715 for stage IVA, THR, and BMI and 0.727 after adding EBV DNA. In the broader same-institution cohort, the association persisted but was attenuated (HR, 1.55; 95% CI, 1.14-2.10; P = 0.005). Conclusion: IMVS is an exploratory, low-cost risk-stratification tool that may complement, rather than replace, TNM stage and plasma EBV DNA. Prospective external validation and recalibration of the data-derived thresholds are required before clinical use.
SN - 2234-943X
ER -