鼻咽癌患者化疗周期的综合策略：来自两个流行中心的真实世界数据指导决策

Integrated strategies for chemotherapy cycles in nasopharyngeal carcinoma patients: Real-world data from two epidemic centers guiding decision-making.

作者信息

Zhan Zejiang, Huang Yingying, Zhou Jiayu, Cai Zhuochen, Huang Haoyang, Deng Ying, Qiu Wenze, Cao Xun, Chen Xi, Liang Chixiong, Zhang Lulu, Guo Xiang, Yuan Taize, Lyu Xing

机构信息

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

Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, China.

出版信息

Chin J Cancer Res. 2023 Apr 30;35(2):126-139. doi: 10.21147/j.issn.1000-9604.2023.02.04.

DOI:10.21147/j.issn.1000-9604.2023.02.04

PMID:37180835

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10167606/

Abstract

OBJECTIVE

Two cycles of induction chemotherapy (IC) followed by 2 cycles of platinum-based concurrent chemoradiotherapy (CCRT) (2IC+2CCRT) for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) is widely adopted but not evidence-confirmed. This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy, toxicity and cost-effectiveness.

METHODS

This real-world study from two epidemic centers used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses. The enrolled patients were divided into three groups based on treatment modality: Group A (2IC+2CCRT), Group B (3IC+2CCRT or 2IC+3CCRT) and Group C (3IC+3CCRT). Long-term survival, acute toxicities and cost-effectiveness were compared among the groups. We developed a prognostic model dividing the population into high- and low-risk cohorts, and survivals including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS) were compared among the three groups according to certain risk stratifications.

RESULTS

Of 4,042 patients, 1,175 were enrolled, with 660, 419, and 96 included in Groups A, B and C, respectively. Five-year survivals were similar among the three groups after PSM and confirmed by IPTW. Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A (52.1% 41.5% 25.2%; 41.7% 32.7% 25.0%) as were grade 3-4 nausea/vomiting and oral mucositis (29.2% 15.0% 6.1%; 32.3% 25.3% 18.0%). Cost-effective analysis suggested that 2IC+2CCRT was the least expensive, while the health benefits were similar to those of the other groups. Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients, while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals, mainly reflected by LRRFS.

CONCLUSIONS

In LA-NPC patients, 2IC+2CCRT was the optimal choice regarding efficacy, toxicity and cost-effectiveness; however, 2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high- and low-risk populations, respectively.

摘要

目的

对于局部晚期鼻咽癌（LA-NPC），采用两个周期的诱导化疗（IC），随后进行两个周期的铂类同步放化疗（CCRT）（2IC+2CCRT）的方案被广泛采用，但尚无循证依据。本研究旨在确定2IC+2CCRT在疗效、毒性和成本效益方面的临床价值。

方法

这项来自两个肿瘤中心的真实世界研究采用倾向评分匹配（PSM）和逆概率加权（IPTW）分析。根据治疗方式将纳入的患者分为三组：A组（2IC+2CCRT）、B组（3IC+2CCRT或2IC+3CCRT）和C组（3IC+3CCRT）。比较三组的长期生存率、急性毒性和成本效益。我们建立了一个预后模型，将人群分为高风险和低风险队列，并根据特定的风险分层比较三组的总生存期（OS）、无进展生存期（PFS）、无远处转移生存期（DMFS）和无局部区域复发生存期（LRRFS）。

结果

在4042例患者中，1175例被纳入研究，A组、B组和C组分别有660例、419例和96例。PSM后三组的五年生存率相似，并经IPTW证实。C组和B组的3-4级中性粒细胞减少和白细胞减少显著高于A组（52.1% 41.5% 25.2%；41.7% 32.7% 25.0%），3-4级恶心/呕吐和口腔黏膜炎也是如此（29.2% 15.0% 6.1%；32.3% 25.3% 18.0%）。成本效益分析表明，2IC+2CCRT成本最低，而健康效益与其他组相似。进一步研究表明，2IC+2CCRT在高风险患者中往往与较短的PFS相关，而3IC+3CCRT可能导致低风险个体的PFS较差，主要体现在LRRFS上。