Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
J Cancer Res Clin Oncol. 2018 Nov;144(11):2231-2243. doi: 10.1007/s00432-018-2721-6. Epub 2018 Aug 14.
To retrospectively investigate the optimal regimen of concurrent chemotherapy for nasopharyngeal carcinoma (NPC) by comparing clinical outcomes of patients who received platinum-based and non-platinum-based concurrent chemoradiotherapy (CCRT) regimens.
Based on a prospectively maintained database from 1998 to 2013 in an endemic area, a total of 4608 newly diagnosed, biopsy-proven, and non-disseminated NPC patients were identified and allocated into three cohorts based on concurrent chemotherapy regimens: cisplatin-based (CP) chemotherapy cohort, other platinum-based (OP) chemotherapy cohort, and non-platinum-based (NP) chemotherapy cohort. Overall survival (OS) and disease-free survival (DFS) were estimated using the Cox proportional hazards model and propensity score analysis of treatment using an inverse probability weighting model (PSA/IPTW). Finally, sensitivity analysis estimated the effects of potential unmeasured confounders.
The median follow-up time was 68.5 months (range 2-194 months). The multivariate Cox model showed that NP regimens were significantly related with worse survival compared with CP or OP regimens (OS: HR 1.51, 95% CI 1.16-2.00, P = 0.002; HR 1.68, 95% CI 1.24-2.27, P = 0.001; DFS: HR 1.31, 95% CI 1.03-1.66, P = 0.031; HR 1.50, 95% CI 1.14-1.97, P = 0.004, respectively). Meanwhile, no significant survival difference was found between OP and CP regimens. The PSA/IPTW method, CCRT-specific and III-IVB NPC cohort subgroup analysis showed similar results. Sensitivity analysis confirmed the robustness of our results.
Platinum-based concurrent chemotherapy, including both CP and OP regimens, yields better survival benefits for non-metastatic NPC patients than the NP regimen and remains the optimal regimen for these patients.
通过比较接受铂类和非铂类同期放化疗（CCRT）方案的患者的临床结果，回顾性研究鼻咽癌（NPC）的最佳同期化疗方案。
根据 1998 年至 2013 年在一个流行地区前瞻性维护的数据库，共确定了 4608 例新诊断、经活检证实和非播散的 NPC 患者，并根据同期化疗方案分为三组：顺铂为基础（CP）化疗组、其他铂类（OP）化疗组和非铂类（NP）化疗组。使用 Cox 比例风险模型和逆概率加权模型（PSA/IPTW）对治疗的倾向评分分析来估计总生存率（OS）和无病生存率（DFS）。最后，敏感性分析估计了潜在未测量混杂因素的影响。
中位随访时间为 68.5 个月（范围 2-194 个月）。多变量 Cox 模型显示，NP 方案与 CP 或 OP 方案相比，生存明显较差（OS：HR 1.51，95%CI 1.16-2.00，P=0.002；HR 1.68，95%CI 1.24-2.27，P=0.001；DFS：HR 1.31，95%CI 1.03-1.66，P=0.031；HR 1.50，95%CI 1.14-1.97，P=0.004）。同时，OP 和 CP 方案之间的生存差异无统计学意义。PSA/IPTW 方法、CCRT 特异性和 III-IVB NPC 亚组分析也得出了相似的结果。敏感性分析证实了我们结果的稳健性。
对于非转移性 NPC 患者，铂类同期化疗，包括 CP 和 OP 方案，比 NP 方案具有更好的生存获益，仍是这些患者的最佳方案。
