Objectives To develop a nomogram that assists in selecting nasopharyngeal carcinoma (NPC) patients suitable for induction chemotherapy. Materials and methods This retrospective study included NPC patients who underwent multiphasic contrast‑enhanced DECT (comprising non-contrast, arterial, and venous phase scanning) between May 2019 and December 2023. The relationships between quantitative DECT-derived parameters and treatment response to induction chemotherapy were analyzed using logistic regression analysis. The predictive performance of a nomogram integrating key predictors was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 294 patients (median age, 53 years; interquartile range, 46–59 years; 224 men) were included. Among these, 215 were responders and 79 were non-responders. The normalized iodine concentration in the arterial phase (nICarterial) (odds ratio (OR), 0.71; 95% confidence interval (CI), 0.52–0.98; p = 0.036), arterial enhancement fraction (AEF) (OR, 1.45; 95% CI, 1.04–2.00; p = 0.026), and extracellular volume fraction (ECVf) (OR, 0.65; 95% CI, 0.15–0.87; p = 0.019) of tumors were identified as independent predictors of chemotherapy response. This nomogram demonstrated excellent performance (AUC = 0.803 [95% CI, 0.740–0.864]) across all participants, as well as in subgroup analyses of Epstein-Barr virus DNA (high and low) (AUC: 0.761, 0.799) and across five subgroups with different chemotherapy regimens (AUC, 0.773–0.833). Conclusions We developed a comprehensive nomogram to predict treatment response to induction chemotherapy by integrating nICarterial, AEF, and ECVf. This nomogram demonstrated superior predictive performance compared to the individual parameters when assessed separately. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> To date, no reliable method has been established to predict the efficacy of induction chemotherapy for nasopharyngeal carcinoma prior to treatment. <Emphasis Type="BoldItalic">Findings</Emphasis> nICarterial, AEF, and ECVf were the independent predictors of induction chemotherapy response, and the combined nomogram demonstrated strong performance to predict response. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> The multiphasic contrast‑enhanced parameters derived from dual-energy CT offer a noninvasive approach to predict treatment response to induction chemotherapy and identify nasopharyngeal carcinoma patients who may benefit from induction chemotherapy. Graphical Abstract

Evaluation of induction chemotherapy response using multiphasic dual-energy CT in nasopharyngeal carcinoma

期刊论文
发表日期：

2025年3月20日

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Huanhuan Ren,
Junhao Huang,
Daihong Liu,
Yao Huang,
Xinying Ren,
Jing Zhang,
Yong Tan,
Hong Yu,
Jiahui Zheng,
Lin Tang,
Ying Wang,
Jiuquan Zhang

摘要

Objectives

To develop a nomogram that assists in selecting nasopharyngeal carcinoma (NPC) patients suitable for induction chemotherapy.

Materials and methods

This retrospective study included NPC patients who underwent multiphasic contrast‑enhanced DECT (comprising non-contrast, arterial, and venous phase scanning) between May 2019 and December 2023. The relationships between quantitative DECT-derived parameters and treatment response to induction chemotherapy were analyzed using logistic regression analysis. The predictive performance of a nomogram integrating key predictors was assessed using the area under the receiver operating characteristic curve (AUC).

Results

A total of 294 patients (median age, 53 years; interquartile range, 46–59 years; 224 men) were included. Among these, 215 were responders and 79 were non-responders. The normalized iodine concentration in the arterial phase (nIC_arterial) (odds ratio (OR), 0.71; 95% confidence interval (CI), 0.52–0.98; p = 0.036), arterial enhancement fraction (AEF) (OR, 1.45; 95% CI, 1.04–2.00; p = 0.026), and extracellular volume fraction (ECVf) (OR, 0.65; 95% CI, 0.15–0.87; p = 0.019) of tumors were identified as independent predictors of chemotherapy response. This nomogram demonstrated excellent performance (AUC = 0.803 [95% CI, 0.740–0.864]) across all participants, as well as in subgroup analyses of Epstein-Barr virus DNA (high and low) (AUC: 0.761, 0.799) and across five subgroups with different chemotherapy regimens (AUC, 0.773–0.833).

Conclusions

We developed a comprehensive nomogram to predict treatment response to induction chemotherapy by integrating nIC_arterial, AEF, and ECVf. This nomogram demonstrated superior predictive performance compared to the individual parameters when assessed separately.

Key Points

Question To date, no reliable method has been established to predict the efficacy of induction chemotherapy for nasopharyngeal carcinoma prior to treatment.

Findings nIC_arterial, AEF, and ECVf were the independent predictors of induction chemotherapy response, and the combined nomogram demonstrated strong performance to predict response.

Clinical relevance The multiphasic contrast‑enhanced parameters derived from dual-energy CT offer a noninvasive approach to predict treatment response to induction chemotherapy and identify nasopharyngeal carcinoma patients who may benefit from induction chemotherapy.

Graphical Abstract