Development and Validation of a Novel Diagnostic Nomogram Model Using Serum Oxidative Stress Markers and AURKA for Prediction of Nasopharyngeal Carcinoma

Figures & data

Table 1 Clinical Characteristics of the Study Population and Their Comparisons

	NPC (n=92)	Healthy Control (n=93)	P value
Gender			<0.001^a
Male (n/%)	65(71%)	39(41%)
Female (n/%)	27(29%)	55(59%)
Age (years)	51.66±10.96	54.49±11.52	0.089^b
BMI (kg/m^2)	19.65±8.61	20.91±5.80	0.244 ^a
GSH (μmol/L)	4.13±5.14	8.84±11.06	<0.001^a
MDA (nmol/mL)	2.2±0.82	1.45±0.93	<0.001^a
SOD (U)	17.61±3.12	21.08±3.61	<0.001^a
AURKA (ng/mL)	0.8283±0.0089	0.8189±0.0098	<0.001^a
Clinical stage
Stage I	2 (2%)
Stage II	9 (10%)
Stage III	20 (22%)
Stage IV	61 (66%)
Treatment
Chemotherapy	62(67%)
Radiotherapy	5(5%)
Concurrent chemoradiotherapy	25(27%)

Notes: P-value estimated by student Wilcoxon test^a or t-test^b.

Abbreviations: BMI, body mass index; GSH, glutathione; SOD, superoxide dismutase; MDA, malondialdehyde; AURKA, aurora kinase.

Table 2 Comparisons of Clinical Characteristics in Different Clinical Stages of NPC

	Stage I (n=2)	Stage II (n=9)	Stage III (n=20)	Stage IV (n=61)	P value
Gender					0.087
Male (n/%)	0(0%)	8(88.9%)	13(65%)	44(72.1%)
Female (n/%)	2(100%)	1(11.1%)	7(35%)	17(27.9%)
Age (years)	31.50±3.54	51.44±9.74	51.00±10.95	52.57±10.82	0.103
BMI (kg/m^2)	20.17±0.20	23.71±3.05	22.87±2.95	22.85±3.66	0.456
Smoking					0.334
Never	2(100%)	4(44.4%)	14(70%)	17(27.9%)
Ever	0(0%)	5(55.6%)	6(30%)	27(44.3%)
Consumption of alcohol					0.463
Never	2(100%)	6(66.7%)	17(85%)	26(42.6%)
Ever	0(0%)	3(33.3%)	3(15%)	18(29.5%)
EBV DNA					0.675
>3	0(0%)	2(22.2%)	2(10%)	12(19.6%)
<3	2(100%)	7(77.8%)	18(90%)	32(52.4%)
Family history of cancer	0(100%)	2(22.2%)	2(10%)	2(3.2%)	0.160
DM					0.964
Yes	0(0%)	1(11.1%)	2(10%)	7(11.5%)
No	2(100%)	8(88.9%)	18(90%)	54(88.5%)
Hypertension					0.775
Yes	0(0%)	2(22.2%)	3(15%)	14(22.9%)
No	2(100%)	7(77.8%)	17(85%)	47(77.1%)
GSH (μmol/L)	13.26±5.86	11.86±10.91	5.49±2.65	2.24±2.35	<0.001
SOD (U)	23.15±0.65	21.54±0.99	18.43±1.90	16.59±2.99	<0.001
MDA (nmol/mL)	1.73±0.46	1.43±0.28	1.76±0.26	2.47±0.87	0.009
AURKA (ng/mL)	0.8098±0.0049	0.8215±0.0027	0.8241±0.0045	0.8313±0.0089	0.005

Abbreviations: BMI, body mass index; EBV, Epstein-Barr virus; DM, diabetes mellitus; GSH, glutathione; SOD, superoxide dismutase; MDA, malondialdehyde; AURKA, aurora kinase A.

Table 3 Multivariate Linear Regression Analyses of Factors Associated with Serum AURKA Levels

Variables	Standardized β	t	P value
Infection of NPC	0.388	5.453	<0.001
MDA (nmol/mL)	0.152	2.129	0.035

Abbreviations: NPC, nasopharyngeal carcinoma; MDA, malondialdehyde.

Table 4 Multivariate Logistic Analyses of Factors for NPC Diagnosis

Variables	OR	95% CI	P value
SOD(U)	0.801	0.701–0.914	0.001
MDA (nmol/mL)	3.103	1.652–5.830	<0.001
AURKA (ng/mL)	2.693	1.195–7.984	<0.001
Gender	4.084	1.557–10.712	0.004

Abbreviations: SOD, superoxide dismutase; MDA, malondialdehyde; AURKA, aurora kinase A; OR, odds ratio; CI, confidence interval.

Figure 1 Nomogram for diagnosis of NPC.

Abbreviations: SOD, superoxide dismutase; MDA, malondialdehyde; AURKA, aurora kinase A; NPC, Nasopharyngeal carcinoma.

Figure 2 Decision curve analysis of the nomogram. (A) the validation cohort; (B) the traning cohort.

Figure 3 Calibration and DCA curve of the nomogram. (A) Calibration curve of the training cohort; (B) Calibration curve of the validation cohort, the dashed line represents the original performance, and the solid dashed line represents the performance during validation by bootstrapping (B = 1000 repetitions). (C) DCA curve of the training cohort; (D) DCA curve of the validation cohort. None: All patients receive no specific intervention, representing the scenario where the Nomogram model is not applied for prediction, indicating that all patients are not diagnosed with NPC. ALL: The predictive results of the Nomogram model are used to intervene in all patients, representing the scenario where all patients are diagnosed with NPC. The red line illustrates the net benefit of the Nomogram model relative to the default strategy at different threshold probabilities.