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CCRT+AC in different subgroups was compared by Kaplan-Meier survival curves. The RCS combining the radiomic signature, TNM stage and EBV DNA demonstrated significantly higher C-indices than TNM stage for predicting 5-year PFS, LRRFS, DMFS and OS in the training and validation cohorts. In the high-risk group (RCS score≥0.25), CCRT+AC achieved significantly better PFS, LRRFS, DMFS and OS than IC+CCRT. In the low-risk group (RCS score0.25), IC+CCRT yielded significantly better outcomes than CCRT+AC. The RCS provides a noninvasive way to