Lin Jie-Yi, Lu Zi-Jian, Li Su-Chen, Luo Dong-Hua, Liu Ting, Zhang Wan-Ru, Yang Zhen-Chong, Mo Hao-Yuan, Mai Hai-Qiang, Liu Sai-Lan
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China.
Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China.
Ther Adv Med Oncol. 2024 Oct 9;16:17588359241286222. doi: 10.1177/17588359241286222. eCollection 2024.
To evaluate the prognostic value of an integrated model consisting of tumour response to induction chemotherapy (IC) and gross tumour volume (GTV) after IC in nasopharyngeal carcinoma (NPC) and elucidate optimal cumulative cisplatin dose (CCD) in concurrent chemoradiotherapy (CCRT) for different subgroups.
This retrospective study enrolled 896 patients with NPC diagnosed from 2010 to 2017 receiving IC plus radiotherapy. The primary endpoint was disease-free survival (DFS). Cut-off points for GTV were combined with IC response to develop an integrated model. Propensity score matching (PSM) was used to adjust for potential confounders. Survival outcomes and acute toxicity were compared between the different CCD groups.
Unsatisfactory IC response and large GTV after IC were correlated with poor survival outcomes; the AUC increased to 0.668 when these factors were incorporated. The integrated model classified patients into three groups. After PSM, radiotherapy alone and CCRT demonstrated similar efficacy in the low-risk group (complete response (CR)/partial response (PR) and GTV <68 cm after IC). In the intermediate-risk group (CR/PR but GTV ⩾68 cm), CCD of >200 mg/m and 101-200 mg/m increased the 5-year DFS rates (83.7% vs 81.1% vs 65.3%, = 0.042). In the high-risk group (stable disease/progressive disease and any GTV), the use of different CCDs did not result in significantly different survival outcomes ( = 0.793). Additionally, high CCD was significantly associated with increased incidence of grade 1-4 acute toxicity.
The integrated model incorporating IC response and GTV after IC demonstrates satisfactory value in risk stratification and the potential to guide individualised decision-making in CCD selection. Balancing toxicity and efficacy, RT alone seems to be the optimal treatment for patients in low-risk groups and 200 mg/m might be the optimal dose for intermediate-risk groups. Moreover, increasing CCD does not benefit patients in high-risk groups, and treatment options for these patients require further consideration.
评估由鼻咽癌（NPC）诱导化疗（IC）后的肿瘤反应和IC后的大体肿瘤体积（GTV）组成的综合模型的预后价值，并阐明不同亚组在同步放化疗（CCRT）中顺铂的最佳累积剂量（CCD）。
这项回顾性研究纳入了896例在2010年至2017年期间诊断为NPC并接受IC加放疗的患者。主要终点是无病生存期（DFS）。GTV的截断点与IC反应相结合以建立综合模型。倾向评分匹配（PSM）用于调整潜在的混杂因素。比较不同CCD组之间的生存结果和急性毒性。
IC反应不理想和IC后GTV较大与生存结果较差相关；纳入这些因素后，AUC增加到0.668。综合模型将患者分为三组。PSM后，低风险组（IC后完全缓解（CR）/部分缓解（PR）且GTV<68 cm³）单纯放疗和CCRT显示出相似的疗效。在中风险组（CR/PR但GTV⩾ sixty-eight cm³）中，CCD>200 mg/m²和101 - 200 mg/m²可提高5年DFS率（83.7%对81.1%对65.3%，P = 0.042）。在高风险组（疾病稳定/进展性疾病且任何GTV）中，使用不同的CCD并未导致生存结果有显著差异（P = 0.793）。此外，高CCD与1 - 4级急性毒性发生率增加显著相关。
纳入IC反应和IC后GTV的综合模型在风险分层中显示出令人满意的价值，并有可能指导CCD选择中的个体化决策。在平衡毒性和疗效方面，单纯放疗似乎是低风险组患者的最佳治疗方法，200 mg/m²可能是中风险组的最佳剂量。此外，增加CCD对高风险组患者无益处，这些患者的治疗选择需要进一步考虑。
