Xiang Zhen-Fei, Hu Dan-Fei, Xiong Hua-Cai, Li Ming-Yao, Zhang Zhan-Chun, Shen Er-Dong, Li Wang-Zhong, Xiang Yan-Qun
Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo 315040, China.
Department of Medical Oncology, the First People Hospital of Yueyang, Yueyang, China.
Oral Oncol. 2021 Jun;117:105284. doi: 10.1016/j.oraloncology.2021.105284. Epub 2021 Apr 9.
Chemoradiotherapy is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC). We aimed to reveal factors associated with chemotherapy use and evaluate chemotherapy's benefit in patients with stage III NPC stratified by lymph node status.
Overall, 1452 patients with stage III NPC who underwent radiotherapy with (n = 1361) or without (n = 91) chemotherapy were identified in the SEER database. We examined predictors for chemotherapy use using logistic regression analysis. We compared all-cause mortality (ACM) and cancer-specific mortality (CSM) using the Kaplan-Meier method. Cox regression and competing risk analyses were used to evaluate the benefit of chemotherapy. The inverse probability of treatment weighting (IPTW) approach was applied to reduce selection bias and adjust for competing risks. Subgroup analyses and interaction effects were explored.
Factors including age, sex, insured status, tumor grade, and N category were associated with chemotherapy use. Chemotherapy was associated with decreased 5-year ACM (31.4% vs. 48.4%, p < 0.001) and CSM (25.5% vs. 35.8%; p = 0.017) in stage III NPC patients. The IPTW-adjusted hazard ratio for 5-year ACM was 0.57 (95% CI: 0.38-0.86, p = 0.008), whereas IPTW-adjusted sub-hazard ratio for 5-year CSM was 0.62 (95% CI: 0.42-0.93, p = 0.003). A significant interaction effect existed between lymph node status and treatment modality. Chemotherapy offered a significant survival benefit in node-positive stage III NPC. However, no chemotherapy benefit for the node-negative disease was observed.
Chemotherapy adds survival benefit in stage III NPC, especially in patients with node-positive disease. The magnitude of chemotherapy benefit in node-negative stage III NPC warrants further investigation.
放化疗是局部晚期鼻咽癌（NPC）的标准治疗方法。我们旨在揭示与化疗使用相关的因素，并评估化疗对按淋巴结状态分层的III期NPC患者的益处。
在监测、流行病学与最终结果（SEER）数据库中，共识别出1452例接受了放疗的III期NPC患者，其中1361例接受了化疗，91例未接受化疗。我们使用逻辑回归分析来研究化疗使用的预测因素。我们使用Kaplan-Meier方法比较全因死亡率（ACM）和癌症特异性死亡率（CSM）。使用Cox回归和竞争风险分析来评估化疗的益处。采用治疗权重逆概率（IPTW）方法来减少选择偏倚并调整竞争风险。进行亚组分析和交互作用分析。
年龄、性别、保险状况、肿瘤分级和N分期等因素与化疗使用相关。化疗与III期NPC患者5年ACM降低（31.4%对48.4%，p<0.001）和CSM降低（25.5%对35.8%；p=0.017）相关。5年ACM的IPTW调整风险比为0.57（95%置信区间：0.38-0.86，p=0.008），而5年CSM的IPTW调整亚风险比为0.62（95%置信区间：0.42-0.93，p=0.003）。淋巴结状态与治疗方式之间存在显著的交互作用。化疗在淋巴结阳性的III期NPC中提供了显著的生存益处。然而，未观察到化疗对淋巴结阴性疾病有益。
化疗可增加III期NPC患者的生存益处，尤其是淋巴结阳性疾病患者。化疗对淋巴结阴性III期NPC的益处程度值得进一步研究。
