Prognostic evaluation of stage I-IVa nasopharyngeal carcinoma: integrating PET/CT parameters, inflammatory and clinical features

To investigate prognostic 18 F-FDG PET/CT parameters and develop a nomogram integrating inflammatory markers and clinicopathological characteristics for predicting progression-free survival (PFS) in stage I-IVa nasopharyngeal carcinoma (NPC). Stage I-IVa NPC patients who underwent pretreatment 18 F-FDG PET/CT were retrospectively collected. The 18 F-FDG PET and clinicopathologic parameters were analyzed. The correlation among PET parameters was evaluated with Spearman’s rho test. ROC curve was used to evaluate the predictive performance and calculate the optimal cut-off values for grouping. The survival analyses were performed by Kaplan-Meier analysis and log-rank test. Prognostic factors were identified using Cox regression, and a nomogram was constructed and validated. Eighty‑six patients were enrolled (63 [73.26%] males, mean age 48.38 ± 11.91 years). Heterogeneity factor (HF) and metabolic tumor volume (MTV) showed strong correlation ( r = 0.88, P < 0.01). ROC curve analysis indicated HF and MTV exhibited good predictive value for 1-, 3-, and 5-year PFS (HF: AUC = 0.817, 0.678, and 0.672; MTV: AUC = 0.866, 0.685, and 0.670), with the best prognostic efficacy for 1-year PFS. HF, systemic immune-inflammation index (SII), overall stage, and concurrent chemoradiotherapy were independent predictors of 5-year PFS. The nomogram demonstrated high predictive ability for PFS, with AUCs of 0.83–0.86 and a C-index of 0.78, further supported by its clinical utility. The novel multifactor nomogram combining HF with SII, overall stage, and treatment strategy (concurrent chemoradiotherapy) demonstrates superior prognostic predictive performance, improving accuracy and enabling personalized assessment in I-IVa stage NPC patients management.