优化老年鼻咽癌患者同步放化疗受益人群的顺铂累积剂量：一项真实世界研究
Optimizing the cumulative cisplatin dose for concurrent chemoradiotherapy beneficiaries among elderly nasopharyngeal carcinoma patients: a real world study.
作者信息
Wu Yan-Ling, He Shuiqing, He Danjie, Gao Yongxiang, Huang Ying, Jing Jin
机构信息
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, Guangdong, China.
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
出版信息
Sci Rep. 2024 Dec 28;14(1):30652. doi: 10.1038/s41598-024-69811-8.
This study aimed to find a safe and effective cumulative cisplatin dose (CCD) for concurrent chemoradiotherapy (CCRT) beneficiaries among elderly nasopharyngeal carcinoma (NPC) patients. A total of 765 elderly (≥ 60 years old) NPC patients treated with cisplatin-based CCRT and IMRT-alone from 2007 to 2018 were included in this study. RPA-generated risk stratification was used to identify CCRT beneficiaries. CCDs were divided into CCD = 0, 0 < CCD ≤ 80, 80 < CCD ≤ 160 and 160 < CCD ≤ 300 mg/m and their OS and nephrotoxicity compared. Pre-treatment plasma EBV DNA and clinical stage were incorporated into the RPA model to perform risk stratification. All patients were classified into either a high-risk group (n = 158, Stage IV), an intermediate-risk group (n = 193, EBV DNA > 2000 copy/mL & Stage I, II, III) or a low-risk group (n = 414, EBV DNA ≤ 2000 copy/mL & Stage I, II, III). The 5 year OS of CCRT vs. IMRT alone in the high-, intermediate- and low-risk groups after balancing covariate bias were 60.1 vs 46.6% (p = 0.02), 77.8 vs 64.6% (p = 0.03) and 86.2 vs 85.0% (p = 0.81), respectively. The 5 year OS of patients receiving CCD = 0, 0 < CCD ≤ 80, 80 < CCD ≤ 160 and 160 < CCD ≤ 300 mg/m after balancing covariate bias in the high-risk group were 45.2, 48.9, 73.4 and 58.3% (p = 0.029), in the intermediate-risk group they were 64.6, 65.2, 76.8 and 83.6% (p = 0.038), and in the low-risk group they were 85.0, 68.1, 84.8 and 94.0% (p = 0.029), respectively. In the low-risk group, the 5 year OS of Stage III patients receiving CCD = 0, 0 < CCD ≤ 80, 80 < CCD ≤ 160 and 160 < CCD ≤ 300 mg/m were 83.5, 76.9, 85.5 and 95.5% (p = 0.044), respectively. No Grade 3-4 nephrotoxicity occurred. Therefore, in our study, Stage I, II, & EBV DNA > 2000copy/ml and Stage III, IV elderly NPC patients may be CCRT beneficiaries. 80 < CCD ≤ 300 mg/m is recommended for the high-risk (Stage IV) group, and 160 < CCD ≤ 300 mg/m for the intermediate-risk (Stage I, II, III & EBV DNA > 2000copy/ml) and low-risk (Stage III & EBV DNA ≤ 2000 copy/ml) groups. No grade 3-4 nephrotoxicity occurred in any of the CCD groups.
本研究旨在为老年鼻咽癌（NPC）患者中接受同步放化疗（CCRT）的患者找到安全有效的顺铂累积剂量（CCD）。本研究纳入了2007年至2018年期间接受基于顺铂的CCRT和单纯调强放疗（IMRT）的765例老年（≥60岁）NPC患者。采用递归分区分析（RPA）生成的风险分层来确定CCRT受益患者。CCD分为CCD = 0、0 < CCD ≤ 80、80 < CCD ≤ 160和160 < CCD ≤ 300mg/m²，并比较其总生存期（OS）和肾毒性。将治疗前血浆EB病毒（EBV）DNA和临床分期纳入RPA模型进行风险分层。所有患者分为高危组（n = 158，IV期）、中危组（n = 193，EBV DNA > 2000拷贝/mL且I、II、III期）或低危组（n = 414，EBV DNA ≤ 2000拷贝/mL且I、II、III期）。在平衡协变量偏差后，高危、中危和低危组中CCRT与单纯IMRT的5年OS分别为60.1%对46.6%（p = 0.02）、77.8%对64.6%（p = 0.03）和86.2%对85.0%（p = 0.81）。在高危组中，平衡协变量偏差后接受CCD = 0、0 < CCD ≤ 80mg/m²、80 < CCD ≤ 160mg/m²和160 < CCD ≤ 300mg/m²的患者5年OS分别为45.2%、48.9%、73.4%和58.3%（p = 0.029）；在中危组中分别为64.6%、65.2%、76.8%和83.6%（p = 0.038）；在低危组中分别为85.0%、68.1%、84.8%和94.0%（p = 0.029）。在低危组中，接受CCD = 0、0 < CCD ≤ 80mg/m²、80 < CCD ≤ 160mg/m²和160 < CCD ≤ 300mg/m²的III期患者5年OS分别为83.5%、76.9%、85.5%和95.5%（p = 0.044）。未发生3 - 4级肾毒性。因此，在我们的研究中，I、II期且EBV DNA > 2000拷贝/mL以及III、IV期老年NPC患者可能是CCRT受益患者。推荐高危（IV期）组的CCD为80 < CCD ≤ 300mg/m²，中危（I、II、III期且EBV DNA > 2000拷贝/mL）和低危（III期且EBV DNA ≤ 2000拷贝/mL）组为CCD为160 < CCD ≤ 300mg/m²。任何CCD组均未发生3 - 4级肾毒性。
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