Prognostic value of body composition combined with Epstein-Barr virus DNA and platelet-to-lymphocyte ratio in locally advanced nasopharyngeal carcinoma

To evaluate the prognostic value of body composition parameters combined with clinical factors in patients with locally advanced nasopharyngeal carcinoma (LA-NPC). Body composition parameters were assessed in patients with LA-NPC during radiotherapy. Based on the occurrence of disease progression, patients were divided into the non-recurrence/metastasis group and the recurrence/metastasis group. Clinical characteristics and body composition parameters were compared between the two groups. Independent predictors of progression-free survival (PFS) were identified, and a predictive model was constructed and validated. After radiotherapy, reductions in body composition parameters were significantly greater in the recurrence/metastasis group than in the non-recurrence/metastasis group ( P < 0.05). Immunotherapy, pre-radiotherapy Epstein-Barr virus (EBV) DNA level, pre-radiotherapy platelet-to-lymphocyte ratio (PLR), skeletal muscle mass, and phase angle were independent predictors of 3-year PFS in patients with LA-NPC. Among these, skeletal muscle mass exhibited the highest predictive performance (area under the curve [AUC] = 0.952). The nomogram incorporating all predictors had higher predictive efficacy, with an AUC of 0.987, a sensitivity of 1.00, and a specificity of 0.92, along with good calibration and clinical utility. A prognostic model incorporating immunotherapy status, pre-radiotherapy EBV DNA level, pre-radiotherapy PLR, skeletal muscle mass, and phase angle can effectively predict the prognosis of patients with LA-NPC. Not applicable