列线图辅助的晚期鼻咽癌个体化诱导化疗方案选择。

Nomogram-aided individual induction chemotherapy regimen selection in advanced nasopharyngeal carcinoma.

机构信息

Center for Translational Medicine, Precision Medicine Institute, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province 510080, China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China.

出版信息

Oral Oncol. 2021 Nov;122:105555. doi: 10.1016/j.oraloncology.2021.105555. Epub 2021 Oct 4.

DOI:10.1016/j.oraloncology.2021.105555

PMID:34619463

Abstract

OBJECTIVE

We undertook this study to clarify how TPF, TP and PF induction chemotherapy (IC) regimens benefit for nasopharyngeal carcinoma (NPC) patients with different risk of disease progression.

MATERIALS AND METHODS

Patients with newly diagnosed, stage III-IVA NPC were included. A quantitative nomogram was built using the independent prognostic factors identified for disease-free survival (DFS). Patients were stratified into low-risk and high-risk groups by the nomogram. Survival outcomes and toxicities between different IC regimens were compared.

RESULTS

In total, 1647 (41.0%), 1123 (28.0%) and 1242 (31.0%) patients received TPF, PF and TP regimen, respectively. Consequently, 2253 (56.2%) patients were clarified as low-risk group and the other 1759 (43.8%) as high-risk group. Survival outcomes did not significantly differ between TPF, PF and TP regimens within the low-risk group. However, TPF was associated with significantly improved 3-year DFS (76.2% vs. 67.5% vs. 68.3%), overall survival (88.3% vs. 84.1% vs. 83.9%), distant metastasis-free survival (81.9% vs. 75.0% vs. 77.4%) and locoregional relapse-free survival (92.0% vs. 87.5% vs. 86.9%; all P < 0.05) compared with PF and TP within high-risk group. Multivariate analysis also confirmed these findings. Toxicity analysis showed that TP regimen has the highest percentage of grade 3-5 hematologic toxicities while PF regimen achieved the lowest percentages of overall grade 3-5 adverse events.

CONCLUSIONS

Patients with high risk should receive TPF for better efficacy and PF may be a better choice for low-risk patients with regard to less grade 3-5 toxicities.

摘要

目的

本研究旨在阐明 TPF、TP 和 PF 诱导化疗（IC）方案如何使疾病进展风险不同的鼻咽癌（NPC）患者获益。

材料与方法

纳入新诊断的 III-IVA 期 NPC 患者。使用无疾病生存（DFS）的独立预后因素建立了一个定量列线图。根据列线图将患者分为低风险组和高风险组。比较不同 IC 方案的生存结局和毒性。

结果

共有 1647（41.0%）、1123（28.0%）和 1242（31.0%）例患者分别接受了 TPF、PF 和 TP 方案。因此，2253（56.2%）例患者被确定为低风险组，1759（43.8%）例患者为高风险组。低风险组内，TPF、PF 和 TP 方案之间的生存结局无显著差异。然而，TPF 与显著改善的 3 年 DFS（76.2%比 67.5%比 68.3%）、总生存（88.3%比 84.1%比 83.9%）、无远处转移生存（81.9%比 75.0%比 77.4%）和无局部区域复发生存（92.0%比 87.5%比 86.9%；均 P<0.05）相关，而高风险组内 PF 和 TP 方案则不然。多变量分析也证实了这些发现。毒性分析表明，TP 方案的 3-5 级血液学毒性发生率最高，而 PF 方案的总 3-5 级不良事件发生率最低。