Chen Chuanben, Chen Qinyan, Xu Yuanji, Zheng Wei, Lin Zhizhong, Wu Zijie, Ye Wangzhong, Huang Xinyi, Lin Xiurong, Bai Penggang
Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, People's Republic of China.
Graduate School, Fujian Medical University, Fuzhou 350000, Fujian Province, People's Republic of China.
Cancer Manag Res. 2020 Sep 18;12:8613-8621. doi: 10.2147/CMAR.S260402. eCollection 2020.
To investigate whether juvenile patients with nasopharyngeal carcinoma (NPC) in China have better prognosis than their adult counterparts in the intensity-modulated radiation therapy (IMRT) era, after controlling for potential confounding variables.
Data pertaining to 1139 patients with newly diagnosed NPC without metastasis, who were treated with IMRT at our hospital, were retrospectively analyzed. Of these, 60 patients were juvenile (age ≤18 years) diagnosed between January 2003 and December 2018, while 1079 patients were adults (≤65 years) diagnosed between January 2013 and December 2014. To minimize the influence of selection and confounding bias, 1:2 propensity score matching (PSM) was used. Overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were estimated using the Kaplan-Meier method and between-group differences assessed using the Log rank test. The long-term toxicity of the juvenile patients was evaluated according to the criteria of the Radiation Therapy Oncology Group (RTOG) and the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Five-year OS of juvenile and adult patients were 88.07% and 85.08%, respectively. Before PSM, OS, PFS, DMFS, or LRFS were comparable in the two groups (all > 0.05). After PSM, OS, DFS, and LRFS in the juvenile group were markedly longer than that in adults ( = 0.005, = 0.027, and = 0.024, respectively). With respect to long-term toxicity, the most common adverse effects in juvenile patients were cervix fibrosis, ototoxicity, and xerostomia. However, except for two patients who developed grade 3 ototoxicity, all adverse effects were within grade 2.
In the IMRT era, juvenile Chinese patients with NPC had better 5-year OS, DFS, and LRFS than their adult counterparts. The adverse events in the juvenile cohort were relatively mild; however, the risk of severe ototoxicity should not be neglected.
在控制潜在混杂变量后，研究中国鼻咽癌（NPC）青少年患者在调强放射治疗（IMRT）时代的预后是否优于成年患者。
回顾性分析我院1139例初诊无转移的NPC患者接受IMRT治疗的数据。其中，60例为青少年患者（年龄≤18岁），于2003年1月至2018年12月确诊，1079例为成年患者（≤65岁），于2013年1月至2014年12月确诊。为尽量减少选择和混杂偏倚的影响，采用1:2倾向评分匹配（PSM）。采用Kaplan-Meier法估计总生存期（OS）、无病生存期（DFS）、局部区域无复发生存期（LRFS）和远处转移无复发生存期（DMFS），并采用Log rank检验评估组间差异。根据放射肿瘤学组（RTOG）标准和不良事件通用术语标准（CTCAE）第5.0版评估青少年患者长期毒性。
青少年和成年患者的5年总生存率分别为88.07%和85.08%。在PSM之前，两组的总生存期、无进展生存期、远处转移无复发生存期或局部区域无复发生存期均具有可比性（均>0.05）。PSM后，青少年组的总生存期、无病生存期和局部区域无复发生存期明显长于成年组（分别为P = 0.005、P = 0.027和P = 0.024）。关于长期毒性，青少年患者最常见的不良反应是颈部纤维化、耳毒性和口干。然而，除2例发生3级耳毒性的患者外，所有不良反应均在2级以内。
在IMRT时代，中国青少年NPC患者的5年总生存期、无病生存期和局部区域无复发生存期优于成年患者。青少年队列中的不良事件相对较轻；然而，严重耳毒性的风险不容忽视。
