Yang Huiyun, Liu Yuanyuan, Zhang Rongjun, Ye Yaomin, Chen Qiuqiu, Qin Qinghua, Huang Liying, Li Xi, Cai Rui, Tang Huaying, Jiang Wei
Department of Radiation Oncology, Guilin Medical University Affiliated Hospital, Guilin 541001, PR China.
Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou 543002, PR China.
Oral Oncol. 2020 Nov;110:104897. doi: 10.1016/j.oraloncology.2020.104897. Epub 2020 Jul 14.
Aim of this study was to evaluate the prognostic value of the tumor volume reduction rate (TVRR) of neoadjuvant chemotherapy (NACT) in patients with locoregional advanced nasopharyngeal carcinoma (NPC).
We collected the clinical data of 263 patients with locoregional advanced NPC receiving NACT and subsequent radiotherapy from two hospitals: a training cohort (n = 130) was obtained from one hospital and a validation cohort was obtained the other hospital (n = 133). By follow-up and calculating the TVRR of all patients, the prognostic value of the TVRR was analyzed though a univariate and multivariate Cox regression model. A cut-off point of the TVRR relating to survival was explored by means of the Youden index, and the prognostic value of the TNM stage plus TVRR was measured by creating receiver operating characteristic (ROC) curves.
12.6%, a cut-off point of TVRR, was found to best predict DFS. Patients with a TVRR > 12.6% had better DFS (hazard ratio, 0.160, 95% confidence interval 0.072-0.354; P < 0.001), LRRFS (0.064, 0.013-0.310; 0.001) and DMFS (0.274, 0.106-0.711; 0.008) than patients with a TVRR ≤ 12.6%. The TVRR was a significant independent prognostic factor for OS, DFS, LRRFS and DMFS. Combining the TVRR and TNM stage enhanced the ability to predict DFS and LRRFS.
The TVRR of NACT is an independent prognostic factor for patients with locoregional advanced NPC receiving radiotherapy. Adding the TVRR to the original TNM staging system improves the prognostic value for locoregional advanced NPC.
本研究旨在评估新辅助化疗（NACT）的肿瘤体积缩小率（TVRR）对局部区域晚期鼻咽癌（NPC）患者的预后价值。
我们收集了两家医院263例接受NACT及后续放疗的局部区域晚期NPC患者的临床资料：一个训练队列（n = 130）来自一家医院，另一个验证队列来自另一家医院（n = 133）。通过随访并计算所有患者的TVRR，采用单因素和多因素Cox回归模型分析TVRR的预后价值。通过约登指数探索与生存相关的TVRR切点，并通过绘制受试者工作特征（ROC）曲线来衡量TNM分期加TVRR的预后价值。
发现TVRR的切点为12.6%时对无病生存期（DFS）的预测效果最佳。TVRR>12.6%的患者在DFS（风险比，0.160，95%置信区间0.072 - 0.354；P<0.001）、无局部区域复发生存期（LRRFS，0.064，0.013 - 0.310；P = 0.001）和无远处转移生存期（DMFS，0.274，0.106 - 0.711；P = 0.008）方面均优于TVRR≤12.6%的患者。TVRR是总生存期（OS）、DFS、LRRFS和DMFS的显著独立预后因素。将TVRR与TNM分期相结合可增强对DFS和LRRFS的预测能力。
NACT的TVRR是接受放疗的局部区域晚期NPC患者的独立预后因素。将TVRR纳入原有的TNM分期系统可提高局部区域晚期NPC的预后价值。
