Zhao Xiaoyan, Tian Ling, Chen Yun, Yang Qing, Xie Tao, Chen Modong, Rao Jinhui, Yang Meng, Huang Ning, Ren Yanxin
Department of Head and Neck Surgery, Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Department of Pathology, Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Front Oncol. 2024 Nov 27;14:1475176. doi: 10.3389/fonc.2024.1475176. eCollection 2024.
Nasopharyngeal carcinoma (NPC) is a prevalent form of head and neck cancer, particularly in specific regions with a higher incidence. The optimal treatment strategy for locally advanced NPC (stage III and IVA, LA-NPC) involves various combinations of induction chemotherapy (IC), concurrent chemoradiotherapy (CCRT), and adjuvant chemotherapy (AC), each with distinct advantages. This one institutional study aims to retrospectively analysis the efficacy and clinical outcomes of IC with CCRT (IC+CCRT), CCRT with AC (CCRT+AC), and the comprehensive approach of IC followed by CCRT and subsequently AC (IC+CCRT+AC) in the management of LA-NPC.
A total of 352 LA-NPC patients were included: 173 accepted IC+CCRT, 60 received CCRT+AC, and 119 underwent IC+CCRT+AC. The primary endpoints including overall survival (OS) and progression-free survival (PFS), were assessed using the Kaplan-Meier method and log-rank test.
The median follow-up was 61.2 months (1-216 months). There was no significant difference in 5-year OS and PFS between IC group and no IC group, extending the observation time to 90 months, the OS and PFS were significantly better in IC group than no IC group (OS: 76% vs. 70%,P<0.05; PFS: 76% vs. 71%, P<0.05). Patients with 1, 2, or 3 cycles of IC had higher 5-year OS and PFS than those with more than 3 cycles (1-4 cycles IC OS: 89% vs. 87% vs. 88% vs. 79%, P<0.05; 1-4 cycles IC PFS: 87% vs. 85% vs. 85% vs. 70%, P<0.05). NP regimen demonstrated higher OS and PFS than TP, PF, and TPF regimens (OS: 95% vs. 82% vs. 85% vs. 71%, P<0.05; PFS: 93% vs. 83% vs. 81% vs. 80%, P<0.05). The 5-year OS and PFS were significantly better in AC group than no AC group (OS: 82% vs. 72%, P<0.05; PFS: 81% vs. 69%, P<0.05). In the AC group, there was no differential effect of chemotherapy cycles and chemotherapy regimens on patients' OS and PFS. In the ThNh group, patients receiving IC+CCRT+AC had higher OS and PFS compared to those receiving IC+CCRT, with no significant difference in the rest (OS: 85% VS 66% P<0.05; PFS: 78% VS 62%, P<0.05).
CCRT combined with IC or AC could benefit LA-NPC patients. The IC+CCRT +AC regimen was most beneficial for NPC patients with later T and N stages.
鼻咽癌（NPC）是头颈部癌症的一种常见形式，在特定地区发病率较高。局部晚期鼻咽癌（III期和IVA期，LA-NPC）的最佳治疗策略涉及诱导化疗（IC）、同步放化疗（CCRT）和辅助化疗（AC）的各种组合，每种组合都有其独特优势。本单机构研究旨在回顾性分析IC联合CCRT（IC+CCRT）、CCRT联合AC（CCRT+AC）以及IC后序贯CCRT再序贯AC（IC+CCRT+AC）综合方案在LA-NPC治疗中的疗效和临床结局。
共纳入352例LA-NPC患者：173例接受IC+CCRT，60例接受CCRT+AC，119例接受IC+CCRT+AC。使用Kaplan-Meier法和对数秩检验评估包括总生存期（OS）和无进展生存期（PFS）在内的主要终点。
中位随访时间为61.2个月（1-216个月）。IC组和非IC组之间5年OS和PFS无显著差异，将观察时间延长至90个月，IC组的OS和PFS显著优于非IC组（OS：76%对70%，P<0.05；PFS：76%对71%，P<0.05）。接受1、2或3周期IC的患者5年OS和PFS高于接受超过3周期IC的患者（1-4周期IC OS：89%对87%对88%对79%，P<0.05；1-4周期IC PFS：87%对85%对85%对70%，P<0.05）。NP方案的OS和PFS高于TP、PF和TPF方案（OS：95%对82%对85%对71%，P<0.05；PFS：93%对83%对81%对80%，P<0.05）。AC组的5年OS和PFS显著优于非AC组（OS：82%对72%，P<0.05；PFS：81%对69%，P<0.05）。在AC组中，化疗周期和化疗方案对患者OS和PFS无差异影响。在ThNh组中，接受IC+CCRT+AC的患者OS和PFS高于接受IC+CCRT的患者，其余方面无显著差异（OS：85%对66%，P<0.05；PFS：78%对62%，P<0.05）。
CCRT联合IC或AC可使LA-NPC患者获益。IC+CCRT+AC方案对T和N分期较晚的NPC患者最有益。
