Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, PR China.
Oral Oncol. 2021 Nov;122:105539. doi: 10.1016/j.oraloncology.2021.105539. Epub 2021 Sep 20.
The goal of this study was to explore the benefits of S-1/capecitabine as maintenance therapy in locoregionally advanced nasopharyngeal carcinoma (NPC) patients with different risks of treatment failure.
A total of 2205 eligible, locoregionally advanced NPC patients were recruited for this retrospective study. Multivariate Cox regression analysis was performed to identify optimal predictors of overall survival (OS) and distant metastasis-free survival (DMFS) for constructing the nomograms. Patients were stratified into high-risk or low-risk groups based on the total score of the nomograms. Propensity score matching (PSM) was performed to match the maintenance and non-maintenance cohorts in different risk groups. A log-rank test was performed to evaluate correlations between maintenance therapy and survival.
A nomogram for OS was established (C-index, 0.664; 95% confidence interval, 0.635-0.693). The 5-year OS rate was significantly higher in the low-risk group than in the high-risk group (83.5% vs. 67.2%, P < 0.001). Patients in the high-risk group who received S-1/capecitabine maintenance therapy achieved significant improvement in the 5-year OS rate (82.8% vs. 67.1%, p = 0.034), whereas patients in the low-risk group did not (86.7% vs. 80.9%, P = 0.081). There was no significant difference in OS, DMFS, progression-free survival (PFS), or toxicities between the S-1 and capecitabine groups (all P > 0.05), and overall treatment-related adverse events (AEs) were not severe (grade 1-2).
S-1/capecitabine maintenance therapy could prolong OS for locoregionally advanced NPC patients in the high-risk group. The toxicities of S-1/capecitabine maintenance therapy were mild and tolerable. Our findings can help guide maintenance therapy in locoregionally advanced NPC.
本研究旨在探讨 S-1/卡培他滨维持治疗对不同复发风险局部晚期鼻咽癌（NPC）患者的获益。
本回顾性研究共纳入 2205 例符合条件的局部晚期 NPC 患者。采用多变量 Cox 回归分析确定总生存（OS）和无远处转移生存（DMFS）的最佳预测因素，构建列线图。根据列线图总分将患者分为高危或低危组。在不同风险组中，采用倾向性评分匹配（PSM）对维持治疗组和非维持治疗组进行匹配。采用对数秩检验评估维持治疗与生存的相关性。
建立了 OS 的列线图（C 指数为 0.664；95%置信区间为 0.635-0.693）。低危组的 5 年 OS 率明显高于高危组（83.5% vs. 67.2%，P<0.001）。高危组接受 S-1/卡培他滨维持治疗的患者 5 年 OS 率显著提高（82.8% vs. 67.1%，P=0.034），而低危组患者则无显著提高（86.7% vs. 80.9%，P=0.081）。S-1 组和卡培他滨组的 OS、DMFS、无进展生存（PFS）或毒性均无显著差异（均 P>0.05），且总体治疗相关不良事件（AE）不严重（1-2 级）。
S-1/卡培他滨维持治疗可延长局部晚期 NPC 高危组患者的 OS。S-1/卡培他滨维持治疗的毒性较轻且可耐受。我们的研究结果可为局部晚期 NPC 的维持治疗提供指导。
