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Lee 2019 Pretreatment Plasma EBV-DNA-Augmented NPC RPA Classification
Establishes the adult source-population boundary; it does not add a score point.
The calculator interprets externally assigned categories and does not derive TNM.
N3 uses an EBV-independent published branch; N0-N2 require a compatible numeric EBV-DNA result.
Clinical Context & Background
This route implements the Lee et al. 2019 recursive-partitioning classification for adults with biopsy-confirmed, nonmetastatic nasopharyngeal carcinoma assessed before treatment in the study's radical-IMRT context. It uses externally assigned AJCC/UICC eighth-edition T, N, and M categories and an assay-compatible pretreatment plasma EBV-DNA result.
For N0-N2, the published split is raw EBV-DNA below 500 versus at least 500 copies/mL. N3 is EBV-independent: T1-T2 maps to RPA-III and T3-T4 maps to RPA-IVA. RPA-IVA is the study's RPA label, not an official AJCC/UICC stage group. No TNM category is derived here.
Quantitative EBV-DNA measurements have shown material inter-laboratory variability; incompatible or unknown assay contexts are therefore withheld rather than converted. Historical five-year PFS, OS, and cancer-specific survival values are labeled cohort observations, not individualized probabilities. This implementation does not calculate treatment benefit, recommend therapy, prescribe monitoring, or replace multidisciplinary NPC staging.
Formula Logic
N0-N2: EBV-DNA <500 => RPA-I; >=500 => RPA-II. N3: T1-T2 => RPA-III; T3-T4 => RPA-IVA.Reference Data
| Published branch | Lee 2019 class | Historical 5-year cohort observations |
|---|---|---|
| T1-T4, N0-N2, EBV-DNA <500 copies/mL | RPA-I | PFS 94%; OS 89%; CSS 96% |
| T1-T4, N0-N2, EBV-DNA >=500 copies/mL | RPA-II | PFS 80%; OS 83%; CSS 89% |
| T1-T2, N3 | RPA-III | PFS 64%; OS 83%; CSS 83% |
| T3-T4, N3 | RPA-IVA | PFS 63%; OS 60%; CSS 68% |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- For source-compatible review of an adult with biopsy-confirmed nonmetastatic NPC before treatment, when externally assigned AJCC/UICC eighth-edition T/N/M and pretreatment plasma EBV-DNA documentation are available.
How To Interpret
- Read the RPA label as a historical study classification, not an official TNM replacement.
- Treat the outcome table as source-cohort observations only.
What To Do Next
- Confirm the external TNM assignment, plasma specimen, and assay context in the specialist record.
Limitations
- Not universal across EBV-DNA assays or specimens because quantitative results may vary across laboratories.
- No treatment, monitoring, individualized survival, or recurrence probability is calculated.
Validated Population
Lee et al. 2019 prospective nonmetastatic NPC cohort treated with radical IMRT with or without chemotherapy under AJCC/UICC eighth edition.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed cases passed through the visible production controls across RPA-I, RPA-II, and RPA-III branches.
- The exact 500-copy boundary and the EBV-independent N3 pathway matched the locked Lee 2019 decision table and historical five-year outcome cells.
- No unexpected N/A, stale or non-actionable control, literal undefined/null value, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/nasopharyngeal-cancer-ebv-dna-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/nasopharyngeal-cancer-ebv-dna.json.
: Source identity locked
- Preserved the permanent route while locking the visible identity to the Lee 2019 pretreatment plasma EBV-DNA-augmented NPC recursive-partitioning classification.
- Distinguished the four study RPA labels from official AJCC/UICC stage groups and documented that RPA-IVA is not official stage IVA.
: Inputs and applicability corrected
- Implemented the strict immutable exact twelve-key contract with raw unrounded EBV-DNA, externally assigned AJCC/UICC eighth-edition T/N/M, plasma/assay provenance, pretreatment timing, and source-context gates.
- Removed favorable defaults, pre-binned inputs, Number coercion, unsupported 4,000-copy rules, extra-key effects, and forced classification of incomplete, metastatic, post-treatment, or assay-incompatible records.
: Classification and outcome language corrected
- Restored the exact 500-copy N0-N2 split and EBV-independent N3 T-category branches.
- Labeled five-year PFS, OS, and CSS values as historical source-cohort observations and removed treatment, monitoring, universal-stage, and individualized-probability claims.
- Added quantitative assay harmonization limitations without converting incompatible measurements.
: Full implementation validation completed
- Passed 2,048 deterministic assertions using a separately encoded literal oracle.
- Verified exhaustive T/N/EBV branches, exact threshold and outcome cells, conditional null/assay rules, strict malformed inputs, applicability and provenance precedence, immutable inputs, deterministic traces, UI/content safety, generated assets, report/evidence mirrors, registry, history, and ledger.
Software implementation verification only; not prospective clinical validation.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
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