Peng Hao, Chen Lei, Li Wen-Fei, Guo Rui, Mao Yan-Ping, Zhang Yuan, Zhang Fan, Liu Li-Zhi, Tian Li, Lin Ai-Hua, Sun Ying, Ma Jun
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
Sci Rep. 2016 Apr 13;6:24332. doi: 10.1038/srep24332.
The prognostic value of the cumulative cisplatin dose (CCD) remains controversial for patients with nasopharyngeal carcinoma (NPC) receiving only concurrent chemoradiotherapy (CCRT). We retrospectively reviewed 549 consecutive patients with non-metastatic, histologically-proven NPC treated using intensity-modulated radiotherapy (IMRT) at Sun Yat-sen university cancer center. Patient survival between different CCD groups were compared. The cut-off value of pre-treatment plasma EBV DNA (pre-DNA) and CCD based on disease-free survival (DFS) were 1460 copies/ml (AUC, 0.691; sensitivity, 0.717; specificity, 0.635) and 240 mg/m(2) (AUC, 0.506; sensitivity, 0.526; specificity, 0.538), respectively. Of the entire cohort, 92/549 (16.8%) patients received a CCD ≥ 240 mg/m(2) and 457 (83.2%) patients, < 240 mg/m(2). For CCD ≥ 240 mg/m(2) vs. < 240 mg/m(2), the estimated 4-year DFS, overall survival (OS), locoregional-free survival (LRFFS) and distant metastasis-free survival (DMFS) rates were 89.1% vs. 81.3% (P = 0.097), 92.4% vs. 90.0% (P = 0.369), 95.6% vs. 91.2% (P = 0.156), and 91.3% vs. 88.4% (P = 0.375), respectively. For the whole cohort, multivariate analysis identified the CCD was an independent prognostic factor for DFS (HR, 0.515; 95% CI, 0.267-0.995; P = 0.048). However, CCD (≥ 240 mg/m(2)) had no prognostic value in subgroup analysis with stratification by the cut-off value of pre-DNA (P > 0.05 for all rates).
对于仅接受同步放化疗（CCRT）的鼻咽癌（NPC）患者，顺铂累积剂量（CCD）的预后价值仍存在争议。我们回顾性分析了中山大学肿瘤防治中心549例接受调强放疗（IMRT）治疗的非转移性、组织学确诊的NPC患者。比较了不同CCD组患者的生存率。基于无病生存期（DFS）的治疗前血浆EBV DNA（pre-DNA）和CCD的截断值分别为1460拷贝/ml（AUC，0.691；敏感性，0.717；特异性，0.635）和240mg/m²（AUC，0.506；敏感性，0.526；特异性，0.538）。在整个队列中，92/549（16.8%）例患者接受的CCD≥240mg/m²，457例（83.2%）患者接受的CCD＜240mg/m²。对于CCD≥240mg/m²与＜240mg/m²的情况，估计的4年DFS、总生存期（OS）、局部区域无复发生存期（LRFFS）和远处转移无复发生存期（DMFS）率分别为89.1%对81.3%（P = 0.097）、92.4%对90.0%（P = 0.369）、95.6%对91.2%（P = 0.156）和91.3%对88.4%（P = 0.375）。对于整个队列，多因素分析确定CCD是DFS的独立预后因素（HR，0.515；95%CI，0.267 - 0.995；P = 0.048）。然而，在根据pre-DNA截断值分层的亚组分析中，CCD（≥240mg/m²）没有预后价值（所有率的P＞0.05）。
