Prognostic value of the three-lineage cytopenia score in locally advanced nasopharyngeal carcinoma: A retrospective cohort study

Myelosuppression is common during chemoradiotherapy for nasopharyngeal carcinoma (NPC), but the prognostic impact of multilineage cytopenia remains unclear. This retrospective study evaluated a three-lineage cytopenia score in 576 patients with locally advanced NPC. The score (0–3) 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 < 0.001). 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 = 7.545, 95%CI: 3.158–18.028) and a 21.33-fold increased risk of distant metastasis (HR = 21.333, 95%CI: 5.076–89.655). The model incorporating the three-lineage cytopenia score yielded an area under the curve (AUC) of 0.593 (95% CI: 0.533–0.652, P = 0.001), 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.