HCAR score as a prognostic biomarker of survival in locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy

Nasopharyngeal carcinoma (NPC) is an aggressive malignancy of the head and neck that is often diagnosed at a locally advanced stage (LANPC). In such cases, intensity-modulated radiotherapy combined with concurrent chemoradiotherapy (CCRT) is the standard treatment; however, the occurrence of distant metastasis and treatment failure remains prevalent. This study evaluates the prognostic significance of a novel composite score that combines hemoglobin levels and the C-reactive protein-to-albumin ratio (HCAR) in LANPC patients undergoing CCRT. We conducted a retrospective analysis of 233 LANPC patients treated with intensity-modulated radiotherapy and platinum-based CCRT from 2011 to 2020. Receiver operating characteristic curve analysis determined pretreatment hemoglobin (Hb) and C-reactive protein-to-albumin ratio (CAR) cut-offs of 11.0 g/dL and 3.0, respectively, which were utilized to create a three-tiered HCAR score: HCAR-0 (Hb ≥11.0 g/dL and CAR <3.0), HCAR-1 (Hb ≥11.0 g/dL and CAR ≥3.0 or Hb <11.0 g/dL and CAR <3.0), and HCAR-2 (Hb <11.0 g/dL and CAR ≥3.0). The primary endpoint of the study was overall survival (OS), while progression-free survival (PFS) was the secondary endpoint. With a median follow-up of 85.7 months, the median PFS and OS were 66.0 months and 108.0 months, respectively, with 5-year PFS and OS rates of 52.8% and 75.9%. The HCAR score significantly stratified patient outcomes: median PFS was not reached for HCAR-0, 66.0 months for HCAR-1, and 25.0 months for HCAR-2. Median OS also varied significantly, being not reached for HCAR-0, 108.0 months for HCAR-1, and 55.0 months for HCAR-2 (all p < 0.001). Corresponding 10-year PFS rates were 50.2%, 34.4%, and 5.0%, while 10-year OS rates were 68.3%, 41.6%, and 11.1%. Multivariate analysis revealed that the HCAR score remained an independent predictor of both PFS and OS, alongside T and N stage. The HCAR score shows promising prognostic utility for predicting OS and PFS in LANPC; however, performance estimates may be overly optimistic due to the lack of internal validation.