HCAR score as a prognostic biomarker of survival in locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy

Abstract

Nasopharyngeal carcinoma (NPC) is an aggressive malignancy of the head and neck that is often diagnosed at a locally advanced stage (LANPC). In such cases, intensity-modulated radiotherapy combined with concurrent chemoradiotherapy (CCRT) is the standard treatment; however, the occurrence of distant metastasis and treatment failure remains prevalent. This study evaluates the prognostic significance of a novel composite score that combines hemoglobin levels and the C-reactive protein-to-albumin ratio (HCAR) in LANPC patients undergoing CCRT. We conducted a retrospective analysis of 233 LANPC patients treated with intensity-modulated radiotherapy and platinum-based CCRT from 2011 to 2020. Receiver operating characteristic curve analysis determined pretreatment hemoglobin (Hb) and C-reactive protein-to-albumin ratio (CAR) cut-offs of 11.0 g/dL and 3.0, respectively, which were utilized to create a three-tiered HCAR score: HCAR-0 (Hb >= 11.0 g/dL and CAR <3.0), HCAR-1 (Hb >= 11.0 g/dL and CAR >= 3.0 or Hb <11.0 g/dL and CAR <3.0), and HCAR-2 (Hb <11.0 g/dL and CAR >= 3.0). The primary endpoint of the study was overall survival (OS), while progression-free survival (PFS) was the secondary endpoint. With a median follow-up of 85.7 months, the median PFS and OS were 66.0 months and 108.0 months, respectively, with 5-year PFS and OS rates of 52.8% and 75.9%. The HCAR score significantly stratified patient outcomes: median PFS was not reached for HCAR-0, 66.0 months for HCAR-1, and 25.0 months for HCAR-2. Median OS also varied significantly, being not reached for HCAR-0, 108.0 months for HCAR-1, and 55.0 months for HCAR-2 (all p < 0.001). Corresponding 10-year PFS rates were 50.2%, 34.4%, and 5.0%, while 10-year OS rates were 68.3%, 41.6%, and 11.1%. Multivariate analysis revealed that the HCAR score remained an independent predictor of both PFS and OS, alongside T and N stage. The HCAR score shows promising prognostic utility for predicting OS and PFS in LANPC; however, performance estimates may be overly optimistic due to the lack of internal validation.