Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China; 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, China.
Oral Oncol. 2019 May;92:40-45. doi: 10.1016/j.oraloncology.2019.03.015. Epub 2019 Mar 19.
Distant metastasis after chemoradiotherapy remains the leading cause of death in NPC patients. But the effect of local treatment for metastatic sites and its sequence with chemotherapy on prognosis of them are poorly documented.
448 post-treatment metastatic NPC patients were included in our retrospective study. And Cox regression and log-rank tests were applied to investigate the association between topical treatment and its sequence with chemotherapy and survival using the propensity score method (PSM) to adjust for gender, age, Tumor stage, Node stage, metastatic sites, diabetes and smoking with a 1:2 matching protocol.
The 3-year OS was significantly higher in patients who received local treatment of distant metastasis compared with patients who did not (48.8% vs 33.8%, P = 0.001) in primary cohort. PSM identified 120 patients in the cohort with local treatment and 240 in that without and similar survival benefits were observed for the local treatment (3-year OS: 36.2% versus 48.8%, P = 0.011). Subgroup analyses indicated that there was no significant survival difference in patients with different treatment sequence.
In conclusion, post-treatment metastatic NPC patients could be beneficial from local treatment for metastasis but its sequence with palliative chemotherapy does not affect overall survival.
放化疗后远处转移仍然是 NPC 患者死亡的主要原因。但转移性部位的局部治疗效果及其与化疗的先后顺序对其预后的影响尚未得到充分记录。
我们的回顾性研究纳入了 448 例治疗后转移性 NPC 患者。应用 Cox 回归和对数秩检验，通过倾向性评分匹配（PSM）方法，以性别、年龄、肿瘤分期、淋巴结分期、转移部位、糖尿病和吸烟为协变量，调整局部治疗及其与化疗先后顺序与生存的相关性。
在原发性队列中，与未接受远处转移局部治疗的患者相比，接受局部治疗的患者 3 年 OS 显著提高（48.8% vs 33.8%，P=0.001）。PSM 方法在队列中识别出 120 例接受局部治疗的患者和 240 例未接受局部治疗的患者，并且局部治疗的生存获益相似（3 年 OS：36.2%与 48.8%，P=0.011）。亚组分析表明，不同治疗顺序的患者之间没有显著的生存差异。
总之，治疗后转移性 NPC 患者从转移性部位的局部治疗中获益，但与姑息性化疗的先后顺序并不影响总体生存。
