同期放化疗联合诱导化疗的老年鼻咽癌患者的风险分层和受益人群选择。

Risk stratification and beneficiary selection among elderly nasopharyngeal carcinoma patients from concurrent chemoradiotherapy combined with induction chemotherapy.

机构信息

Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.

Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.

出版信息

Cancer Med. 2023 May;12(9):10536-10552. doi: 10.1002/cam4.5789. Epub 2023 Apr 16.

OBJECTIVE

This study aims to evaluate the risk stratification among elderly Nasopharyngeal carcinoma (NPC) patients (≥60 years old) and select the beneficiaries from concurrent chemotherapy (CCRT) combined with induction chemotherapy (IC).

MATERIALS AND METHODS

A total of 909 elderly non-metastatic NPC patients treated with cisplatin-based CCRT or IC + CCRT between January 2007 and December 2016 were included. Prognostic nomograms were generated according to clinical characteristics and serum biomarkers. The survival outcomes of patients treated with CCRT versus IC + CCRT were compared in three well-matched risk groups (high, medium, and low risk) after PSM analysis. Benefit of IC in people older or younger than 70 years and effect of different IC regimens and cycles on prognosis were analyzed.

RESULTS

Nomograms of overall survival (OS) (C-index: 0.64, 95% CI, 0.61-0.89) and disease special survival (DSS) (C-index: 0.65, 95% CI, 0.62-0.71) showed good prognostic accuracy. The nomogram for DSS included variables of age, gender, ACE, EBV DNA, N stage, and T stage. OS included variables of age, smoking history, ACE, ALB, EBV DNA, N stage, and T stage. The corresponding 5-year OS rates of high, medium and low risk groups were 87.4%, 82.2%, and 60.9%, respectively (p < 0.001), while the 5-year DSS rates were 92.2%, 84.3%, and 69.0%, respectively (p < 0.001). In the high risk group, IC + CCRT led to significantly higher 5-year OS and DSS rate compared with CCRT (5-year OS rate, 73.5% versus 51.8%, p = 0.006; 5-year DSS rate, 81.4% versus 61.3%, p = 0.002). While in the medium and low risk groups, OS and DSS were not significantly different (OS: p = 0.259, 0.186; DSS: p = 0.29, 0.094). Subgroup analysis showed in the high risk group, only people younger than 70 years old could benefit from IC. TPF and IC cycles of three could lead to the best survival results.

CONCLUSION

Compared with CCRT, OS, and DSS among high risk elderly patients were significantly improved by the addition of IC in patients younger than 70 years old. TPF and three IC cycles were recommended.

目的

本研究旨在评估老年鼻咽癌（NPC）患者（≥60 岁）的风险分层，并为接受顺铂为基础的同期放化疗（CCRT）或诱导化疗（IC）+CCRT 的患者选择受益人群。

材料与方法

共纳入 909 例 2007 年 1 月至 2016 年 12 月期间接受顺铂为基础的 CCRT 或 IC+CCRT 治疗的老年非转移性 NPC 患者。根据临床特征和血清标志物生成预后列线图。通过 PSM 分析，在三个匹配良好的风险组（高、中、低风险）中比较 CCRT 与 IC+CCRT 治疗的患者的生存结局。分析年龄大于或小于 70 岁的患者接受 IC 的获益，以及不同 IC 方案和周期对预后的影响。

结果

总生存（OS）（C 指数：0.64，95%CI，0.61-0.89）和疾病特异性生存（DSS）（C 指数：0.65，95%CI，0.62-0.71）的列线图具有良好的预后准确性。DSS 列线图包括年龄、性别、ACE、EBV DNA、N 分期和 T 分期等变量。OS 包括年龄、吸烟史、ACE、ALB、EBV DNA、N 分期和 T 分期等变量。高、中、低风险组的 5 年 OS 率分别为 87.4%、82.2%和 60.9%（p<0.001），5 年 DSS 率分别为 92.2%、84.3%和 69.0%（p<0.001）。在高危组中，与 CCRT 相比，IC+CCRT 显著提高了 5 年 OS 和 DSS 率（5 年 OS 率，51.8%比 73.5%，p=0.006；5 年 DSS 率，61.3%比 81.4%，p=0.002）。然而，在中低危组中，OS 和 DSS 无显著差异（OS：p=0.259，0.186；DSS：p=0.29，0.094）。亚组分析显示，在高危组中，只有年龄小于 70 岁的患者从 IC 中获益。TPF 和三个 IC 周期可带来最佳的生存结果。