Machine learning prognostication in nasopharyngeal carcinoma: a european multicentre analysis of survival and risk of second malignancy (2026)

European Archives of Oto-Rhino-Laryngology

Authors

I. Pușcaș, Anda Gâta, P. Rizzo, M. Stellin, V. Rampinelli, D. Tomasini, C. Piazza, Daniele Borsetto, W. Ince, C. Chiesa-Estomba, Maria Landa-Garmendia, P. Surda, Eleanor J. Crossley, Matt Lechner, Teodora Maria Ursu, L. Cernau, Adél Bajcsi, Laura-Silvia Dioşan, C. Chira, Alexandra Roman, V. Gâta, Alexandru Irimie, Silviu Albu

Abstract

Nasopharyngeal carcinoma (NPC) is rare in Europe, and emerging data suggest poorer outcomes in Caucasian patients compared with Asian populations, highlighting the need for region-specific prognostic tools. Inflammation-based biomarkers and artificial intelligence show promise for risk stratification and prediction of survival and second primary cancers (SPCs). We conducted a retrospective multicentre study including 405 NPC patients from six European institutions. Demographic, clinicopathological, and haematologic inflammatory markers were collected, and machine learning algorithms were developed to predict 5-year OS and SPC occurrence. Multiple train–test splitting strategies and machine learning (ML) classifiers were evaluated. Models were tested both with and without systemic inflammatory ratios to assess their added prognostic value. The median age was 52 years, 91.6% of patients were classified as White/European ancestry, and 77.3% received chemoradiotherapy. Five-year OS was 66.6%, while 12.8% developed SPC. The Random Forest classifier achieved the best performance for OS prediction (accuracy 0.74; AUC 0.66) using the complete feature set, while SPC prediction reached an accuracy of 0.80 (AUC 0.74). Exclusion of inflammatory markers resulted in a consistent decline in accuracy across all models. Feature-importance analysis highlighted inflammatory ratios among the strongest predictors for both OS and SPC. The present study was reported according to TRIPOD+AI reporting guidelines. This study presents the first machine-learning prognostic models for nasopharyngeal carcinoma derived from a predominantly Caucasian European multicentre cohort. Systemic inflammatory markers modestly improved overall survival prediction and substantially enhanced second primary cancer risk estimation. The resulting models are transparent, cost-effective, and support the potential benefit of prognostic assessment through machine learning in non-endemic settings.

Citation

@Inproceedings{Pușcaș2026MachineLP,
 author = {I. Pușcaș and Anda Gâta and P. Rizzo and M. Stellin and V. Rampinelli and D. Tomasini and C. Piazza and Daniele Borsetto and W. Ince and C. Chiesa-Estomba and Maria Landa-Garmendia and P. Surda and Eleanor J. Crossley and Matt Lechner and Teodora Maria Ursu and L. Cernau and Adél Bajcsi and Laura-Silvia Dioşan and C. Chira and Alexandra Roman and V. Gâta and Alexandru Irimie and Silviu Albu},
 booktitle = {European Archives of Oto-Rhino-Laryngology},
 title = {Machine learning prognostication in nasopharyngeal carcinoma: a european multicentre analysis of survival and risk of second malignancy},
 year = {2026}
}