Jiang YuTing, Chen KaiHua, Yang Jie, Liang ZhongGuo, Qu Song, Li Ling, Zhu XiaoDong
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
Department of Oncology, Affiliated Wuming Hospital of Guangxi Medical University, Nanning, China.
J Cancer. 2022 Jan 1;13(2):426-435. doi: 10.7150/jca.65315. eCollection 2022.
There is no conclusive on the optimal number of cycles of induction chemotherapy (IC) with the greatest benefit to patient survival. This study aimed to assess the efficiency and acute toxicities of different cycles of IC for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). We reviewed data from patients with LA-NPC treated with IC plus concurrent chemoradiation (CCRT). Propensity score matching (PSM) was applied to match paired patients. After PSM, survival outcomes of matched patients were compared between two and three cycles of IC groups. Univariate and multivariate Cox regression analysis were carried out to identify potentially independent predictors. Treatment-related acute toxicities between the two groups were compared by Pearson X test or Fisher's exact test. In total, 189 pairs were selected. The median follow-up time was 60 months (range 5 to 126 months). There was no difference between two and three cycles of IC in terms of 5-year overall survival (87.0% vs. 89.7%, p = 0.991), distant metastasis-free survival (90.1% vs. 86.8%, p = 0.587), locoregional recurrence-free survival (97.0% vs. 93.8%, p = 0.488), or progression-free survival (79.4% vs. 79.3%, p = 0.896). Multivariate Cox analysis showed that T stage, N stage, and clinical stage were independent prognostic factors. Three cycles of IC were associated with a higher incidence of Grade 1-2 acute toxicity than two cycles during IC period. The efficacy of two cycles of IC achieved similar survival outcomes as three cycles and has a lower incidence of treatment-related acute toxicity.
关于诱导化疗（IC）的最佳周期数对患者生存获益最大这一点尚无定论。本研究旨在评估不同周期的IC对局部晚期鼻咽癌（LA-NPC）患者的疗效和急性毒性。我们回顾了接受IC联合同步放化疗（CCRT）治疗的LA-NPC患者的数据。采用倾向评分匹配（PSM）来匹配配对患者。PSM后，比较IC两周期组和三周期组匹配患者的生存结局。进行单因素和多因素Cox回归分析以确定潜在的独立预测因素。两组之间的治疗相关急性毒性通过Pearson X检验或Fisher精确检验进行比较。总共选择了189对。中位随访时间为60个月（范围5至126个月）。IC两周期组和三周期组在5年总生存率（87.0%对89.7%，p = 0.991）、无远处转移生存率（90.1%对86.8%，p = 0.587）、无局部区域复发生存率（97.0%对93.8%，p = 0.488）或无进展生存率（79.4%对79.3%，p = 0.896）方面无差异。多因素Cox分析显示，T分期、N分期和临床分期是独立的预后因素。IC期间，三周期IC与1-2级急性毒性的发生率高于两周期相关。两周期IC的疗效与三周期相似，且治疗相关急性毒性的发生率较低。
