确定局部晚期鼻咽癌同期放化疗后辅助化疗起始的最佳时机。

Determining the optimal timing of adjuvant chemotherapy initiation after concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma.

机构信息

State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.

出版信息

ESMO Open. 2024 Sep;9(9):103707. doi: 10.1016/j.esmoop.2024.103707. Epub 2024 Sep 9.

DOI:10.1016/j.esmoop.2024.103707

PMID:39255536

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11415671/

Abstract

BACKGROUND

Studies on several malignancies have suggested that the time to commencement of adjuvant chemotherapy (AC) is associated with survival outcomes. There have, however, been no relevant reports of nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

This clinical study examined newly diagnosed patients between April 2017 and December 2020. The primary endpoint was progression-free survival (PFS). Inverse probability of treatment weighting was used to control for confounding factors. Cox models with restricted cubic splines, Kaplan-Meier method and log-rank tests were used to evaluate the relationship between AC timing and survival.

RESULTS

A total of 551 patients were identified [median age, 45 years (interquartile range 36-52 years); 383 (69.5%) male]. Restricted cubic splines demonstrated that the timing of AC initiation had a U-shaped association with PFS. The risk of disease progression decreased within 37 days and subsequently increased. From 37 to 90 days, each additional 7-day delay conferred worse PFS of 1.32 months {hazard ratio (HR): 1.14 [95% confidence interval (CI) 1.01-1.28], P = 0.04}. The cut-off value of the receiver operating characteristic curve for initiation was 69.5 days. At a median follow-up of 48 months, the PFS was significantly better in patients initiated within 69.5 days [HR: 2.18 (95% CI 1.17-4.06), log-rank P = 0.009], with a higher 3-year rate [78.8% (95% CI 75.1% to 82.7%) versus 59.0% (95% CI 42.2% to 82.5%)] than beyond 69.5 days. Positive results were also observed in secondary endpoints. The initiation group was an independent prognostic factor [HR: 2.28 (95% CI 1.42-3.66), P < 0.001].

CONCLUSIONS

The optimal timing of AC initiation is ∼37 days after concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. A delay beyond 69.5 days is associated with compromised survival. Efforts should be made to address the reasons for delays and ensure the timely initiation of AC.

摘要

背景

多项恶性肿瘤研究表明，辅助化疗（AC）的起始时间与生存结局相关。然而，关于鼻咽癌（NPC）尚无相关报道。

患者与方法

本临床研究纳入了 2017 年 4 月至 2020 年 12 月期间新诊断的患者。主要终点为无进展生存期（PFS）。采用逆概率治疗加权法控制混杂因素。采用受限立方样条 Cox 模型、Kaplan-Meier 法和对数秩检验评估 AC 起始时间与生存之间的关系。

结果

共纳入 551 例患者[中位年龄为 45 岁（四分位距 36-52 岁）；383 例（69.5%）为男性]。受限立方样条显示，AC 起始时间与 PFS 呈 U 型关系。在 37 天内，疾病进展的风险降低，随后增加。从 37 天到 90 天，每延迟 7 天，PFS 恶化 1.32 个月[风险比（HR）：1.14（95%置信区间 1.01-1.28），P=0.04]。起始时间的受试者工作特征曲线的截断值为 69.5 天。中位随访 48 个月时，起始时间在 69.5 天内的患者 PFS 显著更好[HR：2.18（95%置信区间 1.17-4.06），对数秩检验 P=0.009]，3 年生存率更高[78.8%（95%置信区间 75.1%-82.7%）vs. 59.0%（95%置信区间 42.2%-82.5%）]。次要终点也观察到阳性结果。起始时间组是独立的预后因素[HR：2.28（95%置信区间 1.42-3.66），P<0.001]。