Department of Radiation Oncology, 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, Guangzhou, China.
Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China.
Cancer Med. 2022 Feb;11(4):1109-1118. doi: 10.1002/cam4.4520. Epub 2021 Dec 24.
We aimed to develop and prospectively validate a risk score model to guide individualized concurrent chemoradiotherapy (CCRT) for patients with stage II nasopharyngeal carcinoma (NPC) in intensity-modulated radiotherapy (IMRT) era.
In total, 1220 patients who received CCRT or IMRT alone were enrolled in this study, including a training cohort (n = 719), a validation cohort (n = 307), and a prospective test cohort (n = 194). Patients were stratified into different risk groups by a risk score model based on independent prognostic factors, which were developed in the training cohort. Survival rates were compared by the log-rank test. The validation and prospective test cohorts were used for validation.
Total tumor volume, Epstein-Barr virus DNA, and lactate dehydrogenase were independent risk factors for failure-free survival (FFS, all p < 0.05). A risk score model based on these three risk factors was developed to classify patients into low-risk group (no risk factor, n = 337) and high-risk group (one or more factors, n = 382) in the training cohort. In the high-risk group, CCRT had better survival rates than IMRT alone (5-year FFS: 82.6% vs. 74.0%, p = 0.028). However, there was no survival difference between CCRT and IMRT alone either in the whole training cohort (p = 0.15) or in the low-risk group (p = 0.15). The results were verified in the validation and prospective test cohorts.
A risk score model was developed and prospectively validated to precisely select high-risk stage II NPC patients who can benefit from CCRT, and thus guided individualized treatment in IMRT era.
我们旨在开发并前瞻性验证一个风险评分模型，以指导调强放疗（IMRT）时代 II 期鼻咽癌（NPC）患者的个体化同期放化疗（CCRT）。
本研究共纳入 1220 例接受 CCRT 或单纯 IMRT 的患者，包括训练队列（n=719）、验证队列（n=307）和前瞻性测试队列（n=194）。基于独立预后因素，通过风险评分模型将患者分层为不同的风险组，该模型在训练队列中建立。通过对数秩检验比较生存率。验证和前瞻性测试队列用于验证。
总肿瘤体积、EBV-DNA 和乳酸脱氢酶是无失败生存（FFS）的独立危险因素（均 P<0.05）。基于这三个危险因素建立了一个风险评分模型，将患者分为低危组（无危险因素，n=337）和高危组（一个或多个因素，n=382）。在高危组中，CCRT 的生存率优于单纯 IMRT（5 年 FFS：82.6% vs. 74.0%，P=0.028）。然而，在整个训练队列（P=0.15）或低危组（P=0.15）中，CCRT 与单纯 IMRT 之间均无生存差异。验证和前瞻性测试队列的结果均得到验证。
我们开发并前瞻性验证了一个风险评分模型，以精确选择可从 CCRT 中获益的高危 II 期 NPC 患者，并指导 IMRT 时代的个体化治疗。
