The Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
Department of Oncology, Fuyang Cancer Hospital, Fuyang 236000, Anhui, China.
Aging (Albany NY). 2022 Aug 26;14(16):6727-6739. doi: 10.18632/aging.204246.
Currently available evidence favors the combination of chemotherapy with concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma (LANPC). However, the optimal timing for additional chemotherapy is unclear. This study was conducted to compare the efficacy and toxicity of induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) versus concurrent chemoradiotherapy plus adjuvant chemotherapy (CCRT+AC).
Two medical centers in China enrolled patients with LANPC (stage III-IVB) between January 2009 and May 2020. Through the use of propensity score matching (PSM), baseline characteristics were balanced. The primary endpoint was overall survival (OS), which was evaluated by the Kaplan-Meier method and log-rank test. Potential independent prognostic factors were identified using univariate and multivariate Cox proportional hazard analyses. Based on the chi-squared test, we compared the adverse events associated with treatment between the groups.
After the implementation of PSM, 159 patients treated with IC+CCRT and 72 patients treated with CCRT+AC were eventually enrolled in this study. There was no significant difference between patients treated with IC+CCRT and CCRT+AC in terms of 3-year OS (94.7% versus 90.9%, p=0.816), progression-free survival (PFS) (91.2% versus 83.1%, p=0.588), locoregional recurrence-free survival (LRFS) (92.5% versus 81.8%, p=0.478), or distant metastasis-free survival (DMFS) (93.4% versus 88.2%, p=0.783). There was no prognostic significance of the treatment for OS, PFS, LRFS, or DMFS (all p > 0.05) in the univariate and multivariate analyses. Patients treated with CCRT+AC had a higher incidence of grade 3 to 4 leucopenia (p=0.001) and neutropenia (p=0.001) than those treated with IC+CCRT.
IC plus CCRT achieved comparable survival outcomes to CCRT plus AC and had a lower incidence of toxicity.
目前的证据支持局部晚期鼻咽癌（LANPC）患者采用化疗联合同期放化疗。然而，最佳的化疗时机尚不清楚。本研究旨在比较诱导化疗联合同期放化疗（IC+CCRT）与同期放化疗联合辅助化疗（CCRT+AC）的疗效和毒性。
中国的两家医疗中心于 2009 年 1 月至 2020 年 5 月期间入组 LANPC（III-IVB 期）患者。通过倾向评分匹配（PSM），平衡了基线特征。主要终点是总生存期（OS），采用 Kaplan-Meier 法和对数秩检验进行评估。采用单因素和多因素 Cox 比例风险分析确定潜在的独立预后因素。基于卡方检验，比较了两组间与治疗相关的不良事件。
实施 PSM 后，最终有 159 例患者接受 IC+CCRT 治疗，72 例患者接受 CCRT+AC 治疗。两组患者的 3 年 OS（94.7% vs. 90.9%，p=0.816）、无进展生存期（PFS）（91.2% vs. 83.1%，p=0.588）、局部区域无复发生存期（LRFS）（92.5% vs. 81.8%，p=0.478）和无远处转移生存期（DMFS）（93.4% vs. 88.2%，p=0.783）无显著差异。单因素和多因素分析均显示，治疗对 OS、PFS、LRFS 或 DMFS 无预后意义（均 p > 0.05）。CCRT+AC 治疗组患者的 3 级至 4 级白细胞减少症（p=0.001）和中性粒细胞减少症（p=0.001）发生率高于 IC+CCRT 治疗组。
IC 联合 CCRT 可获得与 CCRT+AC 相当的生存结果，且毒性发生率较低。
