ArticleJournal of inflammation research2026
Development and Validation of a Neutrophil Percentage-to-Albumin Ratio-Based Nomogram for Predicting Overall Survival in Locally Advanced Nasopharyngeal Carcinoma.
Article in Journal of inflammation research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Hematology-based inflammatory-nutritional composite indices are robust prognostic biomarkers for malignancies due to their survival correlation. This study explored the prognostic value of the neutrophil percentage-albumin ratio (NPAR) - a composite marker reflecting systemic inflammation and nutrition - in locally advanced nasopharyngeal carcinoma (LA-NPC), whose predictive role in LA-NPC survival remains underexplored. Patients and Methods: A retrospective study of 536 LA-NPC patients who received definitive radiotherapy at Guangxi Medical University Cancer Hospital was conducted. Patients were randomized into training (n=321, 60%) and validation (n=215, 40%) cohorts via the `sample()` function in R. NPAR and other continuous variables were dichotomized using optimal cut-offs from the `survminer` package in R. Kaplan-Meier and Log-rank analyses compared survival; least absolute shrinkage and selection operator (LASSO) regression identified key prognostic parameters, with univariate and multivariate Cox regression confirming independent survival factors. A prognostic nomogram was built from these factors, and its predictive efficacy was evaluated via calibration curves (accuracy), Harrell's C-index (discrimination), time-dependent receiver operating characteristic (tROC) curves, and decision curve analysis (DCA; clinical utility). Results: Multivariate Cox regression for overall survival (OS) in the training cohort identified NPAR, age, TNM stage, pretreatment EBV DNA level, and hypertension as independent prognostic factors for LA-NPC. A nomogram integrating these five variables was constructed. Calibration curves, C-index, tROC curves, and DCA confirmed that the nomogram accurately predicted 3- and 5-year OS probabilities, with high consistency between predicted and observed outcomes. Furthermore, the nomogram outperformed the 8th edition TNM staging system in terms of predictive performance, as evidenced by superior C-index, tROC, and DCA results. Conclusion: NPAR, an accessible routine blood-based hematological biomarker, is a promising prognostic indicator for LA-NPC. The nomogram integrating NPAR and key clinical parameters enables more accurate personalized treatment stratification, facilitating precision management and yielding translational potential for improved LA-NPC outcomes.
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