Chen Jing, Liu Tongxin, Sun Quanquan, Jin Ting
Institute of Cancer and Basic Medicine, Chinese Academy of Sciences.
Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences.
Medicine (Baltimore). 2020 Jul 17;99(29):e20443. doi: 10.1097/MD.0000000000020443.
Although common, the use of concurrent chemoradiotherapy with adjuvant chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We, therefore, conducted a retrospective cohort study to investigate whether adjuvant chemotherapy confers survival gains to stage II NPC patients.
In this study, we examined whether combining adjuvant chemotherapy (AC) and/or concurrent chemotherapy with radiotherapy (CCRT) improved survival in patients with stage II NPC. Three hundred thirty-five stage II NPC patients were retrospectively analyzed between June 2003 and June 2016 and received CCRT; some patient groups also received AC every 3 weeks for 2 to 3 cycles.
The median follow-up duration was 72 months for all patients (range, 26-151 months) and the estimated 5-year locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 95.1%, 97.8%, 93.5%, and 94.3%. At the last follow-up, there were no statistically significant differences among the CCRT and CCRT+AC groups in 5-year LRRFS (95.2% vs 94.9%, P = .599), DMFS (98.5% vs 92.4%, P = .152), PFS (93.8% vs 90.2%, P = .599), or OS (95.5% vs 93.9%, P = .682) rates.
The analyses revealed that a combined regimen was not an independent prognostic factor for any survival outcome. However, patients who received CCRT plus AC experienced more acute adverse events than those who received CCRT alone. Thus, the addition of AC to CCRT did not improve survival outcomes, but was associated with higher incidences of acute treatment-associated toxicities than CCRT alone in patients with stage II NPC.
尽管同步放化疗联合辅助化疗在II期鼻咽癌（NPC）治疗中较为常用，但因其临床获益不明确，该治疗方法仍存在争议。因此，我们开展了一项回顾性队列研究，以调查辅助化疗是否能提高II期NPC患者的生存率。
在本研究中，我们研究了辅助化疗（AC）和/或同步放化疗（CCRT）联合使用是否能提高II期NPC患者的生存率。对2003年6月至2016年6月期间接受CCRT的335例II期NPC患者进行回顾性分析；部分患者组还每3周接受2至3个周期的AC治疗。
所有患者的中位随访时间为72个月（范围26 - 151个月），估计5年局部区域无复发生存率（LRRFS）、远处转移无复发生存率（DMFS）、无进展生存率（PFS）和总生存率（OS）分别为95.1%、97.8%、93.5%和94.3%。在最后一次随访时，CCRT组和CCRT + AC组在5年LRRFS（95.2%对94.9%，P = 0.599）、DMFS（98.5%对92.4%，P = 0.152）、PFS（93.8%对90.2%，P = 0.599）或OS（95.5%对93.9%，P = 0.682）率方面无统计学显著差异。
分析表明，联合治疗方案并非任何生存结局的独立预后因素。然而，接受CCRT加AC治疗的患者比仅接受CCRT治疗的患者经历了更多的急性不良事件。因此，在II期NPC患者中，CCRT联合AC并未改善生存结局，但与单独CCRT相比，与更高的急性治疗相关毒性发生率相关。
