Jin Ya-Nan, Tang Qing-Nan, Yao Ji-Jin, Xu Xi-Wei, He Wen-Zhuo, Wang Lei, You Ya-Fei, Peng Kun-Wei, Jiang Chang, Xia Liang-Ping
VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China.
Transl Oncol. 2021 Feb;14(2):100990. doi: 10.1016/j.tranon.2020.100990. Epub 2020 Dec 15.
Little is known about the value of adding concurrent chemotherapy (CC) to radiotherapy for stage II nasopharyngeal carcinoma (NPC) with undetectable (0 copies/mL) pretreatment Epstein-Barr Virus (EBV) DNA in the intensity-modulated radiotherapy (IMRT) era. To address this question, the present study retrospectively reviewed 514 patients with newly diagnosed stage II NPC and undetectable pretreatment EBV DNA from Sun Yat-sen University Cancer Center between March 2008 and October 2016. Clinical characteristics and survival outcomes between concurrent chemoradiotherapy (CCRT) and IMRT alone groups were compared. Propensity score matching analysis was conducted to control for confounding factors. Although CCRT group had significantly higher proportions of stage N1 disease than IMRT alone group before matching (85% vs. 61%, p < 0.001), no statistically significant differences were noted for OS (97.8% vs. 98.1%, p = 0.700), DFS (93.4% vs. 94.5%, p = 0.846), DMFS (96.0% vs. 96.9%, p = 0.762), and LRFS (97.3% vs. 98.1%, p = 0.701). After 1:1 propensity-score matching, 177 pairs were identified. Patients in each group were found to be well balanced in baseline characteristics and risk factors (all P > 0.05). The five-year OS (96.9% vs. 98.2%, p = 0.302), DFS (92.0% vs. 95.2%, p = 0.777), DMFS (95.2% vs. 97.6%, p = 0.896), and LRFS (97.3% vs. 97.6%, p = 0.328) rates remain comparable for both CCRT and RT alone groups. Additionally, subgroup analysis still failed to observe any significant survival benefit for the addition of CC to IMRT for N1 disease (P>0.05 for all). Our results indicated that IMRT alone appeared to achieve comparable survival to CCRT for stage II NPC with undetectable pretreatment EBV DNA.
在调强放射治疗（IMRT）时代，对于治疗前爱泼斯坦-巴尔病毒（EBV）DNA检测不到（0拷贝/毫升）的II期鼻咽癌（NPC）患者，在放疗基础上加用同步化疗（CC）的价值鲜为人知。为解决这一问题，本研究回顾性分析了2008年3月至2016年10月期间中山大学肿瘤防治中心514例新诊断的II期NPC且治疗前EBV DNA检测不到的患者。比较了同步放化疗（CCRT）组和单纯IMRT组的临床特征及生存结局。进行倾向评分匹配分析以控制混杂因素。尽管匹配前CCRT组N1期疾病的比例显著高于单纯IMRT组（85%对61%，p<0.001），但总生存期（OS，97.8%对98.1%，p=0.700）、无病生存期（DFS，93.4%对94.5%，p=0.846）、远处转移无进展生存期（DMFS，96.0%对96.9%，p=0.762）和局部区域复发无进展生存期（LRFS，97.3%对98.1%，p=0.701）均无统计学显著差异。经过1:1倾向评分匹配后，共确定了177对。发现每组患者在基线特征和危险因素方面均衡性良好（所有P>0.05）。CCRT组和单纯放疗组的五年OS（96.9%对98.2%，p=0.302）、DFS（92.0%对95.2%，p=0.777）、DMFS（95.2%对97.6%，p=0.896）和LRFS（97.3%对97.6%，p=0.328）率仍然相当。此外，亚组分析仍未观察到对于N1期疾病在IMRT基础上加用CC有任何显著的生存获益（所有P>0.05）。我们的结果表明，对于治疗前EBV DNA检测不到的II期NPC患者，单纯IMRT似乎能取得与CCRT相当的生存率。
