Peng Hao, Chen Lei, Li Wen-Fei, Zhang Yuan, 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.
Oral Oncol. 2016 Nov;62:78-84. doi: 10.1016/j.oraloncology.2016.10.014. Epub 2016 Oct 19.
The aim of this study is to optimize the cycle for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) receiving neoadjuvant chemotherapy (NCT) in the era of intensity-modulated radiotherapy (IMRT).
Data on 569 locoregionally advanced NPC patients treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance prognostic factors and match patients. Survival outcomes of matched patients between different NCT cycle groups were compared.
The median cycle of NCT was 2 (range, 2-4 cycles) for the whole cohort, and patients were therefore stratified as low cycle (=2) and high cycle (>2) groups. In total, 247 pairs of NPC patients were selected by PSM. Univariate analysis found no significantly prognostic difference between the low cycle and high cycle groups, and multivariate analysis did not establish NCT cycle as an independent factor. However, stratified analysis revealed patients in the low cycle group had better OS than those of patients in the high cycle group (92.4% vs. 80.8%, P=0.029), and NCT was identified as an independent prognostic factor for OS in patients with N2-3 category (HR, 2.252; 95% CI, 1.024-4.953; P=0.043).
Two cycles of NCT may be enough and additional more cycles are not associated with improved survival outcomes for patients with locoregionally advanced NPC in the era of IMRT.
本研究旨在优化调强放疗（IMRT）时代局部晚期鼻咽癌（NPC）患者接受新辅助化疗（NCT）的疗程。
回顾性分析569例接受IMRT治疗的局部晚期NPC患者的数据。采用倾向评分匹配（PSM）方法平衡预后因素并匹配患者。比较不同NCT疗程组中匹配患者的生存结局。
整个队列的NCT中位疗程为2个疗程（范围为2 - 4个疗程），因此患者被分为低疗程（=2个疗程）和高疗程（>2个疗程）组。通过PSM共选择了247对NPC患者。单因素分析发现低疗程组和高疗程组之间无显著预后差异，多因素分析未将NCT疗程确立为独立因素。然而，分层分析显示低疗程组患者的总生存期（OS）优于高疗程组患者（92.4%对80.8%，P = 0.029），并且NCT被确定为N2 - 3期患者OS的独立预后因素（风险比[HR]，2.252；95%置信区间[CI]，1.024 - 4.953；P = 0.043）。
在IMRT时代，对于局部晚期NPC患者，2个疗程的NCT可能就足够了，额外增加疗程与改善生存结局无关。
