Yang Kaixuan, Zhang Qian, Zhang Mengxi, Xie Wenji, Li Mei, Zeng Lei, Wang Qiang, Zhao Jianling, Li Yiping, Li Guangjun
Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2021 Sep 6;11:640077. doi: 10.3389/fonc.2021.640077. eCollection 2021.
The efficiency of concurrent chemotherapy (CC) remains controversial for stage II-IVa nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT). Therefore, we aimed to propose a nomogram to identify patients who would benefit from CC.
A total of 434 NPC patients (stage II-IVa) treated with IC followed by IMRT between January 2010 and December 2015 were included. There were 808 dosimetric parameters extracted by the in-house script for each patient. A dosimetric signature was developed with the least absolute shrinkage and selection operator algorithm. A nomogram was built by incorporating clinical factors and dosimetric signature using Cox regression to predict recurrence-free survival (RFS). The C-index was used to evaluate the performance of the nomogram. The patients were stratified into low- and high-risk recurrence according to the optimal cutoff of risk score.
The nomogram incorporating age, TNM stage, and dosimetric signature yielded a C-index of 0.719 (95% confidence interval, 0.658-0.78). In the low-risk group, CC was associated with a 9.4% increase of 5-year locoregional RFS and an 8.8% increase of 5-year overall survival (OS), whereas it was not significantly associated with an improvement of locoregional RFS (LRFS) and OS in the high-risk group. However, in the high-risk group, patients could benefit from adjuvant chemotherapy (AC) by improving 33.6% of the 5-year LRFS.
The nomogram performed an individualized risk quantification of RFS in patients with stage II-IVa NPC treated with IC followed by IMRT. Patients with low risk could benefit from CC, whereas patients with high risk may require additional AC.
对于接受诱导化疗（IC）后再行调强放疗（IMRT）的II-IVa期鼻咽癌（NPC）患者，同步化疗（CC）的疗效仍存在争议。因此，我们旨在提出一种列线图，以识别能从CC中获益的患者。
纳入2010年1月至2015年12月期间接受IC后再行IMRT治疗的434例II-IVa期NPC患者。通过内部脚本为每位患者提取808个剂量学参数。使用最小绝对收缩和选择算子算法开发剂量学特征。通过Cox回归纳入临床因素和剂量学特征构建列线图，以预测无复发生存期（RFS）。使用C指数评估列线图的性能。根据风险评分的最佳临界值将患者分为低复发风险和高复发风险组。
纳入年龄、TNM分期和剂量学特征的列线图C指数为0.719（95%置信区间，0.658-0.78）。在低风险组中，CC使5年局部区域无复发生存率提高9.4%，5年总生存率提高8.8%，而在高风险组中，CC与局部区域无复发生存率（LRFS）和总生存率的改善无显著相关性。然而，在高风险组中，患者可通过辅助化疗（AC）使5年LRFS提高33.6%而获益。
该列线图对接受IC后再行IMRT治疗的II-IVa期NPC患者的RFS进行了个体化风险量化。低风险患者可从CC中获益，而高风险患者可能需要额外的AC。
