局部区域晚期鼻咽癌的新辅助化疗：一项国家癌症数据库分析。

Neoadjuvant chemotherapy in local-regionally advanced nasopharyngeal carcinoma: A National Cancer Database analysis.

作者信息

Tam Moses, Lee Anna, Wu S Peter, Gerber Naamit K, Li Zujun, Givi Babak, Hu Kenneth, Schreiber David

机构信息

Department of Radiation Oncology, New York University Langone Health, New York, New York.

Department of Radiation Oncology, SUNY Downstate Medical Center, New York, New York.

出版信息

Laryngoscope. 2018 Dec;128(12):2770-2777. doi: 10.1002/lary.27254. Epub 2018 Aug 22.

DOI:10.1002/lary.27254

PMID:30133799

Abstract

OBJECTIVES/HYPOTHESIS: To assess patterns of care and outcomes with the use of neoadjuvant chemotherapy followed by definitive radiation in local-regionally advanced nasopharyngeal carcinoma.

STUDY DESIGN

Retrospective database analysis.

METHODS

We queried the National Cancer Database for patients with T3-4N2 or T1-4N3 nasopharyngeal carcinoma who received concurrent chemoradiotherapy or neoadjuvant chemotherapy followed by radiation. Overall survival (OS) was analyzed using the Kaplan-Meier method, propensity-score matching, and a Cox proportional hazards model adjusting for demographic and disease-specific prognostic factors.

RESULTS

From 2004 to 2014, a total of 1,731 patients were identified, including 504 patients (27%) who received neoadjuvant chemotherapy. Neoadjuvant chemotherapy was used more frequently in years 2008 to 2010 (34%) and 2011 to 2014 (30%) compared with 2004 to 2007 (22%) (χ P = .001). At a median follow-up of 36.6 months, patients had 3-year OS of 66% in the neoadjuvant group compared with 70% in those who received concurrent chemoradiotherapy (log rank P = .29). On subgroup analysis by histology, T stage, and N stage, there remained no differences in OS between the two groups. On multivariable analysis, there was no significant survival difference associated with neoadjuvant chemotherapy (adjusted hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 0.89-1.25, P = .54). In a propensity score-matched population of 1,008 patients (504 with neoadjuvant therapy and 504 without), there was no significant survival difference associated with neoadjuvant chemotherapy (H: 1.13, 95% CI: 0.93-1.38, P = .22).

CONCLUSIONS

Neoadjuvant chemotherapy was used in over 25% of patients, and its use is increasing. However, neoadjuvant chemotherapy was not associated with any differences in survival compared to concurrent chemoradiotherapy.

LEVEL OF EVIDENCE

4 Laryngoscope, 128:2770-2777, 2018.

摘要

目的/假设：评估局部区域晚期鼻咽癌采用新辅助化疗后行根治性放疗的治疗模式及疗效。

研究设计

回顾性数据库分析。

方法

我们在国家癌症数据库中查询T3-4N2或T1-4N3期鼻咽癌患者，这些患者接受了同步放化疗或新辅助化疗后再行放疗。采用Kaplan-Meier法、倾向评分匹配法以及校正人口统计学和疾病特异性预后因素的Cox比例风险模型分析总生存期（OS）。

结果

2004年至2014年，共识别出1731例患者，其中504例（27%）接受了新辅助化疗。与2004年至2007年（22%）相比，新辅助化疗在2008年至2010年（34%）和2011年至2014年（30%）使用更为频繁（χ²检验P = 0.001）。中位随访36.6个月时，新辅助化疗组患者3年总生存率为66%，同步放化疗组为70%（对数秩检验P = 0.29）。按组织学、T分期和N分期进行亚组分析，两组总生存率仍无差异。多变量分析显示，新辅助化疗与生存率无显著差异（校正风险比[HR]：1.05，95%置信区间[CI]：0.89 - 1.25，P = 0.54）。在1008例倾向评分匹配的患者中（504例接受新辅助治疗，504例未接受），新辅助化疗与生存率无显著差异（HR：1.13，95% CI：0.93 - 1.38，P = 0.22）。