Risk factors and clinical prediction model for vertebral artery stenosis following radiotherapy for nasopharyngeal carcinoma.

ObjectiveThis retrospective cohort study aimed to investigate the independent risk factors for vertebral artery stenosis following radiotherapy for nasopharyngeal carcinoma and construct a nomogram-based prediction model to assess its clinical utility.MethodsIn total, 386 nasopharyngeal carcinoma patients who underwent radiotherapy at a tertiary hospital between 2017 and 2023 were included; the median follow-up duration was 23.3 (interquartile range, 12.5-33.7) months, and the incidence of vertebral artery stenosis was 29.8% (115/386). Univariate Cox regression analysis was used to identify factors associated with vertebral artery stenosis, followed by least absolute shrinkage and selection operator (LASSO) regression analyses to determine the key variables. Multivariate Cox regression was applied to identify independent risk factors, which were used to construct a nomogram prediction model. The model's accuracy and predictive performance were evaluated using calibration curves and receiver operating characteristic analysis.ResultsUnivariate Cox regression analysis identified 12 significant variables, among which 4 key factors were selected through LASSO regression analysis. Multivariate Cox regression analysis revealed that V60 (hazard ratio: 1.09, 95% confidence interval: 1.07-1.10, p < 0.001), hyperlipidemia (hazard ratio: 1.66, 95% confidence interval: 1.05-2.64, p = 0.030), and body mass index (hazard ratio: 1.19, 95% confidence interval: 1.15-1.22, p < 0.001) were independent risk factors for vertebral artery stenosis. The nomogram prediction model constructed using these factors demonstrated high predictive performance, with calibration curves indicating excellent agreement between predicted and observed outcomes. Receiver operating characteristic analysis showed that the areas under the curve for 1-, 2-, and 3-year predictions were 0.99, 0.99, and 0.98, respectively.ConclusionThe nomogram model based on multiple clinical parameters demonstrated good performance in predicting the risk of vertebral artery stenosis following radiotherapy for nasopharyngeal carcinoma in internal validation. It may serve as a useful tool for the early identification of high-risk patients and support prognosis management strategies.