Prognostic Value of Pre-Treatment Diffusion Kurtosis Imaging for Progression-Free Survival Prediction in Advanced Nasopharyngeal Carcinoma.

PURPOSE: This study aimed to evaluate the value of diffusion kurtosis imaging (DKI) for prognostic value for long-term PFS in nasopharyngeal carcinoma (NPC). METHODS: A cohort of 295 NPC patients underwent pretreatment 3.0T MRI with DKI to derive mean kurtosis (MK), mean diffusion (MD), and apparent diffusion coefficient (ADC). Clinical parameters (Tumor stage, EBV-DNA, neoadjuvant chemotherapy regimens) were recorded. Follow-up extended to December 2023. Statistical analyses (R software v4.3.0) included univariate/multivariate Cox regression and Kaplan-Meier survival analysis. A prognostic nomogram integrating key predictors was developed. RESULTS: Median 10-year follow-up revealed 2-, 5-, and 10-year PFS rates of 89%, 79%, and 74%, respectively. Univariate Cox regression analysis demonstrated that T stage, Clinical Stages, NAC regimens, ADC_Group, MK_Group, and MD_Group were significant prognostic factors for PFS in NPC (p < 0.05). Multivariate analysis identified Clinical Stage (HR = 2.230, 95% CI 1.44-3.66, p < 0.001), NAC (neoadjuvant chemotherapy) regimens (HR = 0.56, 95% CI 0.35-0.90, p = 0.017), and MK_Group (HR = 0.52, 95% CI 0.33-0.82, p = 0.003) as independent prognostic factors. The MK_Group high exhibited superior survival rates versus MK_Group low (2-year: 94% vs. 81%; 5-year: 85% vs. 66%; 10-year: 79% vs. 64%; all p < 0.05). The nomogram combining Clinical Stage, NAC, and MK_Group demonstrated moderate predictive accuracy for 2-, 5-, and 10-year PFS (AUC = 0.736, 0.718, 0.697). CONCLUSION: Pretreatment MK serves as a robust noninvasive biomarker for long-term PFS in NPC. Integration with Clinical Stage and NAC regimens enhances prognostic stratification, supporting personalized therapeutic strategies.