Department of Oncology, Sichuan Mianyang 404 Hospital, First People's Hospital of Mianyang, Mianyang, China.
Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, China.
Cancer Med. 2024 Feb;13(3):e7029. doi: 10.1002/cam4.7029.
To investigate the correlation between tumor volume reduction rate (TVRR) and prognosis in patients with diverse clinical types of nasopharyngeal carcinoma (NPC) undergoing chemoradiotherapy, thereby aptly categorizing risks and directing the personalized treatment of NPC.
A total of 605 NPC patients with varying clinical types were enrolled in this study and subsequently segregated into six subgroups based on their clinical types and TVRR. To accentuate the efficacy of grouping, Groups 1-6 underwent clustered analysis of hazard atio (HR) values pertaining to progression-free survival (PFS), forming three risk clusters denoted as low, intermediate, and high. The log-rank test was employed to discern differences, and R 4.1.1 was utilized for cluster analysis.
According to survival rates, we classified the first (G2 and G4), second (G1 and G6), and third (G3 and G5) risk clusters as low-, intermediate-, and high-risk, respectively. When comparing risk stratification with the 8th edition of the TNM staging system, our classification exhibited superior predictive prognostic performance. Subgroup analysis of treatments for each risk cluster revealed that the PFS in the neoadjuvant chemotherapy (NACT) + concurrent chemoradiotherapy (CCRT) group surpassed that of the CCRT group significantly (p < 0.05).
The reliance on clinical types and TVRR facilitates risk stratification of NPC during chemoradiotherapy, providing a foundation for physicians to tailor therapeutic strategies. Moreover, the risk cluster delineated for NPC patients during the mid-term of chemoradiotherapy stands as an independent prognostic factor for progression-free survival (PFS), overall survival (OS), distantmetastasis-free survival (DMFS), and local recurrence-free (LRRFS) posttreatment. Additionally, individuals in the high-risk cluster are recommended to undergo adjuvant chemotherapy after CCRT.
探讨不同临床类型鼻咽癌（NPC）患者放化疗后肿瘤体积减少率（TVRR）与预后的相关性，从而对风险进行恰当分类，指导 NPC 的个体化治疗。
共纳入 605 例不同临床类型的 NPC 患者，根据临床类型和 TVRR 将其分为 6 组亚组。为了强调分组的效果，将第 1-6 组进行无进展生存（PFS）风险比（HR）值的聚类分析，形成 3 个风险聚类，分别为低、中、高风险。采用对数秩检验比较差异，使用 R 4.1.1 进行聚类分析。
根据生存率，我们将第 1（G2 和 G4）、第 2（G1 和 G6）和第 3（G3 和 G5）风险聚类分别归类为低、中、高风险。与第 8 版 TNM 分期系统的风险分层相比，我们的分类具有更好的预测预后性能。对每个风险聚类的治疗方案进行亚组分析显示，新辅助化疗（NACT）+同期放化疗（CCRT）组的 PFS 明显优于 CCRT 组（p<0.05）。
在放化疗过程中，依靠临床类型和 TVRR 进行风险分层为医生制定治疗策略提供了依据。此外，在放化疗中期为 NPC 患者划定的风险聚类是 PFS、总生存（OS）、无远处转移生存（DMFS）和治疗后局部无复发生存（LRRFS）的独立预后因素。此外，建议 CCRT 后高风险组患者接受辅助化疗。
