Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Cancer Med. 2021 Jun;10(11):3613-3621. doi: 10.1002/cam4.3917. Epub 2021 May 6.
Conditional survival (CS) and failure hazard estimations can provide important dynamic prognostic information for clinical decision-making and surveillance counseling. The current study aimed to investigate the CS and dynamic failure hazard in non-metastatic nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).
Conditional overall survival (COS) and progression-free survival (CPFS) estimates adjusted for age and gender against each AJCC 8th stage were calculated. Multivariable Cox regression (MCR) models were fitted in the entire population at baseline and subsequently separate MCR models were fitted in patients who have maintained event-free time of 1 to 10 years to generate respective hazard ratio (HR). Annual hazard rates of death and progression over 10 years for each stage were also estimated.
A total of 1993 patients were eligible for analysis. The estimated 5-year OS and PFS for entire cohort were 79.0% and 70.7% at initial diagnosis. After 5 years of event-free follow-up, additional 5-year COS and CPFS increased to 85.9% and 85.5%, respectively. Stage I/II maintained dramatically favorable CS and low hazard (< 5%) of death and progression over time. Relative to stage I/II, stage III manifested non-significantly higher failure hazard for the first 3 years of survivorship and approached to similar level of stage I/II afterwards. Stage IVA presented most impressive improvement in terms of both COS (∆=9.8%) and CPFS (∆ = 16.8%) whereas still drastically inferior to that of stage I-III across all conditional time points. After 4 years of follow-up, progression hazard of stage IVA became relatively steady of approximate 6%.
Survival prospect of non-metastatic NPC improves over years with distinct dynamic patterns across stages, providing important implications for personalized decision-making in terms of both clinical management and surveillance counseling. Stage-dependent and hazard-adapted clinical management and surveillance are warranted.
条件生存（CS）和失败风险估计可为临床决策和监测咨询提供重要的动态预后信息。本研究旨在探讨调强放疗（IMRT）治疗的非转移性鼻咽癌（NPC）的 CS 和动态失败风险。
针对每个 AJCC 第 8 期，计算调整年龄和性别后的总体条件生存率（COS）和无进展生存率（CPFS）估计值。在整个人群的基线和随后的无事件时间为 1 至 10 年的患者中分别拟合多变量 Cox 回归（MCR）模型，以生成各自的风险比（HR）。还估计了每个阶段 10 年内死亡和进展的年危险率。
共有 1993 例患者符合分析条件。整个队列的估计 5 年 OS 和 PFS 分别为初始诊断时的 79.0%和 70.7%。在无事件随访 5 年后，额外的 5 年 COS 和 CPFS 分别增加到 85.9%和 85.5%。I/II 期保持了显著有利的 CS 和较低的死亡和进展风险（<5%）。与 I/II 期相比，III 期在生存的前 3 年内表现出非显著更高的失败风险，随后接近 I/II 期的水平。IVA 期在 COS（∆=9.8%）和 CPFS（∆=16.8%）方面均表现出最显著的改善，而在所有条件时间点上仍明显低于 I-III 期。在 4 年随访后，IVA 期的进展风险变得相对稳定，约为 6%。
非转移性 NPC 的生存前景随着时间的推移而改善，各阶段之间存在明显的动态模式，为临床管理和监测咨询的个性化决策提供了重要启示。需要根据阶段和风险进行临床管理和监测。
