开发和验证基于治疗前 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描 (PET-CT) 放射组学参数和外周血标志物的预后列线图，用于对新发转移性鼻咽癌 (dmNPC) 患者进行风险分层。总共 558 名患者回顾性纳入 2011 年至 2019 年间患有 dmNPC 的患者。符合条件的患者被随机分为训练组和验证组（7:3 比例）。 Cox 回归模型用于确定总生存期 (OS) 的预后因素。使用一致性指数（C 指数）和校准曲线确定预后列线图的预测准确性和判别能力。从训练队列的多变量分析中得出预测死亡的独立因素是乳酸脱氢酶水平、预处理 Epstein-Barr 病毒 DNA、局部区域病灶的总病灶糖酵解、转移病灶的数量和年龄，所有这些都被组装成带有（列线图 B）或不带有 PET-CT 参数（列线图 A）的列线图。列线图 B 预测死亡的 C 指数为 0.70，显着高于列线图 A 的 C 指数值。然后根据使用列线图 B 计算的 OS 分数将患者分为低风险组和高风险组。低风险组的中位 OS 显着高于高风险组（69.60 个月 [95% CI: 58.50-108.66] 对比 21.40 个月 [95% CI: 19.20-23.90]；p＜0.01）。所有结果均在验证队列中得到证实。所提出的列线图（包括 PET-CT 参数）为 dmNPC 患者提供了准确的预后预测，从而能够对这些患者进行有效的风险分层。版权所有 © 2024 Elsevier Ltd。保留所有权利。

To develop and validate a prognostic nomogram based on pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT)radiomics parameters and peripheral blood markers for risk stratification in patients with de novo metastatic nasopharyngeal carcinoma (dmNPC).A total of 558 patients with dmNPC were retrospectively enrolled between 2011 and 2019. Eligible patients were randomly divided into training and validation cohorts (7:3 ratio). A Cox regression model was used to identify prognostic factors for overall survival (OS). The predictive accuracy and discriminative ability of the prognostic nomogram were determined using the concordance index (C-index) and calibration curve.Independent factors derived from multivariable analysis of the training cohort to predict death were lactate dehydrogenase levels, pretreatment Epstein-Barr virus DNA, total lesion glycolysis of locoregional lesions, number of metastatic lesions, and age, all of which were assembled into a nomogram with (nomogram B) or without PET-CT parameters (nomogram A). The C-index of nomogram B for predicting death was 0.70, which was significantly higher than the C-index values for nomogram A. Patients were then stratified into low- and high-risk groups based on the scores calculated using nomogram B for OS. The median OS was significantly higher in the low-risk group than in the high-risk group (69.60 months [95 % CI: 58.50-108.66] vs. 21.40 months [95 % CI: 19.20-23.90]; p＜0.01). All the results were confirmed in the validation cohort.The proposed nomogram including PET-CT parameters yielded accurate prognostic predictions for patients with dmNPC, enabling effective risk stratification for these patients.Copyright © 2024 Elsevier Ltd. All rights reserved.