Department of Oncology, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.
Fujian Center for Safety Evaluation of New Drug, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Drug Target Discovery and Structural and Functional Research, Fuzhou, China.
Am J Otolaryngol. 2022 Jan-Feb;43(1):103193. doi: 10.1016/j.amjoto.2021.103193. Epub 2021 Sep 3.
This study aimed to compare the efficacy between neoadjuvant chemotherapy (NACT) plus intensity-modulated radiotherapy (IMRT) and NACT plus concurrent chemoradiotherapy (CCRT) in patients with nasopharyngeal carcinoma (NPC).
Data from 603 patients with ascending (T4 and N0-1) or descending (T1-2&N3) NPC who were treated at Sun Yat-sen University Cancer Center between October 2009 and February 2012 were retrospectively analyzed. These patients were divided into two groups: NACT+IMRT (n = 302) and NACT+CCRT (n = 301). The primary endpoint was overall survival (OS), which was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards model, and landmark analysis.
In univariate analysis, there was no significant difference in 5-year OS between the NACT+IMRT and NACT+CCRT groups (hazard ration [HR]: 0.69; 95% confidence interval [CI]: 0.47-1.01; P = 0.057). However, after adjustment for age (<45 years, ≥45 years), gender, histological stage (I/II, III), T stage (1/2, 3, 4), and N stage (0/1, 2/3), NACT+IMRT was more effective in improving OS, with a 33% decrease in the risk of death than NACT+CCRT (HR: 0.67; 95%CI: 0.45-0.99). Furthermore, landmark analysis indicated that patients in the NACT+IMRT group had higher OS rates within 24 months (HR: 1.83; 95%CI: 1.00-3.34), whereas those treated with NACT+CCRT had higher OS rates after 24 months (HR, 0.47; 95% CI, 0.29-0.77). We also found significant survival benefits of NACT+IMRT regimen in patients younger than 45 years old (HR: 0.27; 95%CI: 0.14-0.49), and in those at stage T3 (HR: 0.50; 95%CI: 0.27-0.93) and stage N2/3 (HR: 0.52; 95%CI: 0.32-0.83).
Patients with ascending or descending NPC who are treated with NACT+IMRT may have better long-term survival outcomes than those treated with NACT+CCRT, especially the patients younger than 45 years old or in stage T3/N2/N3. Additionally, NACT+IMRT may be a better option than NACT+CCRT in patients within the first 24 months.
本研究旨在比较新辅助化疗（NACT）加调强放疗（IMRT）与 NACT 加同期放化疗（CCRT）在鼻咽癌（NPC）患者中的疗效。
回顾性分析 2009 年 10 月至 2012 年 2 月中山大学肿瘤防治中心收治的 603 例 T4 和 N0-1 或 T1-2&N3 升序（NPC）或降序（NPC）患者的数据。这些患者分为两组：NACT+IMRT（n=302）和 NACT+CCRT（n=301）。主要终点是总生存（OS），采用 Kaplan-Meier 法、对数秩检验、Cox 比例风险模型和 landmark 分析进行分析。
单因素分析显示，NACT+IMRT 组和 NACT+CCRT 组 5 年 OS 无显著差异（风险比[HR]：0.69；95%置信区间[CI]：0.47-1.01；P=0.057）。然而，在校正年龄（<45 岁，≥45 岁）、性别、组织学分期（I/II、III）、T 分期（1/2、3、4）和 N 分期（0/1、2/3）后，NACT+IMRT 可显著提高 OS，死亡风险降低 33%（HR：0.67；95%CI：0.45-0.99）。此外，landmark 分析表明，NACT+IMRT 组患者在 24 个月内的 OS 率更高（HR：1.83；95%CI：1.00-3.34），而 NACT+CCRT 组患者在 24 个月后 OS 率更高（HR：0.47；95%CI：0.29-0.77）。我们还发现 NACT+IMRT 方案在年龄<45 岁（HR：0.27；95%CI：0.14-0.49）和 T3 期（HR：0.50；95%CI：0.27-0.93）和 N2/3 期（HR：0.52；95%CI：0.32-0.83）患者中具有显著的生存获益。
接受 NACT+IMRT 治疗的升序或降序 NPC 患者可能比接受 NACT+CCRT 治疗的患者具有更好的长期生存结果，特别是年龄<45 岁或 T3/N2/N3 期的患者。此外，在最初 24 个月内，NACT+IMRT 可能优于 NACT+CCRT。
