确定局部晚期鼻咽癌口服辅助化疗的最佳疗程
Determining the optimal duration of oral adjuvant chemotherapy in locoregionally advanced nasopharyngeal carcinoma.
作者信息
Cheng Hui, Chen Jie, Li Yifu, Li Yuchen, Tse Chunfung, Shen Bowen, Li Shibing, Chen Qiuyan, Tang Linquan, Mai Haiqiang, Liu Liting
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, PR China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
出版信息
Br J Cancer. 2025 May 6. doi: 10.1038/s41416-025-03033-1.
BACKGROUND
Concurrent chemoradiotherapy (CCRT) followed by adjuvant chemotherapy (AC) is the standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). However, the optimal duration of oral AC remains poorly defined.
METHODS
This study examined newly diagnosed patients between April 2017 and December 2020. The primary endpoint was overall survival (OS). Restricted cubic splines (RCS) and Kaplan-Meier method were used to evaluate the relationship between AC maintenance and survival. Inverse probability of treatment weighting (IPTW) was used to control for confounding factors.
RESULTS
The RCS demonstrated an L-shaped association between oral AC maintenance and OS. The risk of mortality was relatively flat after 12 months. Patients with oral AC duration >186 days (defined by RCS) had a significantly better OS (HR 0.23 [95% CI 0.10-0.55], log-rank p < 0.001), with a higher 3-year OS rate (98.7% [95% CI 96.8-100.0] vs 88.3% [95% CI 82.5-94.5]). For patients with pretreatment Epstein-Barr virus (EBV) DNA level >4000 copies/mL, mortality risk decreased to 1 at 194 days of AC duration.
CONCLUSIONS
The optimal duration of oral AC after CCRT was >186 days (6 months) for LA-NPC. And the maintenance beyond 12 months may not bring additional benefits.
背景
同步放化疗（CCRT）后序贯辅助化疗（AC）是局部晚期鼻咽癌（LA-NPC）的标准治疗方法。然而，口服AC的最佳疗程仍不明确。
方法
本研究纳入了2017年4月至2020年12月期间新诊断的患者。主要终点为总生存期（OS）。采用限制性立方样条（RCS）和Kaplan-Meier法评估AC维持治疗与生存之间的关系。使用逆概率处理加权法（IPTW）来控制混杂因素。
结果
RCS显示口服AC维持治疗与OS之间呈L形关联。12个月后死亡风险相对平稳。口服AC疗程>186天（由RCS定义）的患者OS显著更好（HR 0.23 [95%CI 0.10 - 0.55]，对数秩检验p < 0.001），3年OS率更高（98.7% [95%CI 96.8 - 100.0] 对比88.3% [95%CI 82.5 - 94.5]）。对于治疗前爱泼斯坦-巴尔病毒（EBV）DNA水平>4000拷贝/mL的患者，AC疗程达194天时死亡风险降至1。
结论
对于LA-NPC，CCRT后口服AC的最佳疗程>186天（6个月）。维持治疗超过12个月可能不会带来额外益处。
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