Xu Cheng, Chen Yu-Pei, Liu Xu, Li Wen-Fei, Chen Lei, Mao Yan-Ping, Zhang Yuan, Guo Rui, Zhou Guan-Qun, Tang Ling-Long, Lin Ai-Hua, Sun Ying, Ma Jun
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
Oral Oncol. 2017 Jun;69:99-107. doi: 10.1016/j.oraloncology.2017.04.015. Epub 2017 May 2.
The subgroups of patients with nasopharyngeal carcinoma (NPC) who benefit from induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) remain unclear.
We established prognostic nomograms for overall survival (OS) and disease-free survival (DFS), and validated the nomograms in 1230 patients with NPC and subgroup of 923 patients with locoregionally advanced NPC (LANPC). Three well-matched risk groups (i.e., low, intermediate and high risk) were created via recursive partitioning and 1-to-1 propensity score matching; IC+CCRT was compared with CCRT in each risk group.
Histological type, T category, N category, plasma Epstein-Barr virus deoxyribonucleic acid (and the same factors plus age and neutrophil-lymphocyte ratio) were included in the nomograms for DFS (and OS). Both nomograms had higher c-indexes than the 7th edition staging system in both NPC/LANPC (all P-values≤0.010). The nomogram for OS also had a higher c-index in LANPC than the 8th edition staging system (P-value=0.052). OS was significantly different between all three risk groups in the individualized risk stratification (all P-values<0.001), while the 7th and 8th edition staging systems failed to clearly separate OS for stage II and III disease (P-value=0.415 and 0.347, respectively). IC+CCRT improved OS in intermediate and high risk patients with LANPC compared to CCRT alone (P-value<0.001 and P-value=0.002, respectively).
These prognostic nomograms could accurately guide treatment of individual patients with NPC. IC+CCRT could improve OS for patients with LANPC at intermediate to high risk.
受益于诱导化疗加同步放化疗（IC+CCRT）的鼻咽癌（NPC）患者亚组仍不明确。
我们建立了总生存期（OS）和无病生存期（DFS）的预后列线图，并在1230例NPC患者以及923例局部晚期NPC（LANPC）患者亚组中对列线图进行了验证。通过递归划分和1:1倾向评分匹配创建了三个匹配良好的风险组（即低、中、高风险）；在每个风险组中比较了IC+CCRT与CCRT。
DFS（和OS）列线图纳入了组织学类型、T分期、N分期、血浆EB病毒脱氧核糖核酸（以及相同因素加上年龄和中性粒细胞与淋巴细胞比值）。在NPC/LANPC中，两个列线图的c指数均高于第7版分期系统（所有P值≤0.010）。OS列线图在LANPC中的c指数也高于第8版分期系统（P值=0.052）。在个体化风险分层中，所有三个风险组的OS均有显著差异（所有P值<0.001），而第7版和第8版分期系统未能明确区分II期和III期疾病的OS（P值分别为0.415和0.347）。与单纯CCRT相比，IC+CCRT改善了LANPC中、高风险患者的OS（P值分别<0.001和0.002）。
这些预后列线图可准确指导NPC个体患者的治疗。IC+CCRT可改善中、高风险LANPC患者的OS。
