基于诱导化疗后血浆 Epstein-Barr 病毒 DNA 水平的鼻咽癌患者最佳累积顺铂剂量。
Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on plasma Epstein-Barr virus DNA level after induction chemotherapy.
机构信息
Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, People's Republic of China.
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, People's Republic of China.
出版信息
Aging (Albany NY). 2020 Mar 27;12(6):4931-4944. doi: 10.18632/aging.102920.
PURPOSE
This study aimed to elucidate the optimal cumulative cisplatin dose (CCD) for concurrent chemoradiotherapy (CCRT) according to the post-induction chemotherapy (IC) plasma Epstein-Barr virus (EBV) DNA level.
RESULTS
EBV DNA was detected and undetected in 179 and 370 patients, respectively. Of the entire cohort, 73/549 (13.3%) patients received a total CCD ≥ 160 mg/m and 476/549 (86.7%) patients, <160 mg/m. CCD enhancement was not associated with a survival benefit in patients with undetected EBV DNA after IC. However, among patients with post-IC detectable EBV DNA, higher 3-year PFS and locoregional relapse-free survival (LRFS) rates were observed in those who received a CCD ≥ 160 mg/m. Multivariate analysis also showed CCD was an independent prognostic factor for PFS and LRFS in patients with post-IC detectable EBV DNA.
CONCLUSIONS
CCD enhancement was not associated with a survival benefit in patients with undetected EBV DNA after IC. However, among patients with post-IC detectable EBV DNA, those receiving ≥160 mg/m CCD showed significantly improved 3-year PFS and LRFS.
METHODS
NPC patients (549) treated with IC and CCRT were included. Prognosis was assessed using a multivariate Cox proportional hazards model. Furthermore, grade 1-4 toxicities were compared between different CCD groups.
目的
本研究旨在根据诱导化疗（IC）后血浆 Epstein-Barr 病毒（EBV）DNA 水平阐明同步放化疗（CCRT）的最佳累积顺铂剂量（CCD）。
结果
分别在 179 例和 370 例患者中检测到和未检测到 EBV DNA。在整个队列中，73/549（13.3%）例患者接受的总 CCD≥160mg/m，476/549（86.7%）例患者接受的总 CCD<160mg/m。在 IC 后 EBV DNA 未检测到的患者中，CCD 增强与生存获益无关。然而，在 IC 后 EBV DNA 可检测的患者中，接受 CCD≥160mg/m 的患者的 3 年无进展生存（PFS）和局部区域无复发生存（LRFS）率更高。多变量分析还表明，在 IC 后 EBV DNA 可检测的患者中，CCD 是 PFS 和 LRFS 的独立预后因素。
结论
在 IC 后 EBV DNA 未检测到的患者中，CCD 增强与生存获益无关。然而，在 IC 后 EBV DNA 可检测的患者中，接受 CCD≥160mg/m 的患者的 3 年 PFS 和 LRFS 显著提高。
方法
纳入接受 IC 和 CCRT 治疗的 NPC 患者（549 例）。采用多变量 Cox 比例风险模型评估预后。此外，还比较了不同 CCD 组之间的 1-4 级毒性。
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