调强放疗时代局部晚期鼻咽癌同步放化疗联合或不联合辅助化疗的10年生存结局：一项按高风险和低风险特征分层的回顾性队列研究
Ten-year survival outcomes of concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma in the IMRT era: A retrospective cohort study stratified by high- and low-risk profiles.
作者信息
Li Wang-Jian, Ling Li-Ting, Yao Yue, Tan Kai-Qing, Zhu Bo-Lin, Zhou Li-Qing, Qu Song, Li Ling, Guan Ying, Pan Ling-Hui, Zhu Xiao-Dong, Liang Zhong-Guo
机构信息
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China.
Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, China.
出版信息
Clin Transl Radiat Oncol. 2025 Jun 27;54:101006. doi: 10.1016/j.ctro.2025.101006. eCollection 2025 Sep.
OBJECTIVE
To evaluate 10-year survival outcomes of intensity-modulated radiotherapy (IMRT)-era locoregionally advanced nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT) ± adjuvant chemotherapy (AC), and assess the impact of AC on survival in high-risk and low-risk patients.
METHODS
This retrospective cohort study analyzed 477 non-metastatic NPC patients (2009-2012) treated with CCRT + AC (n = 315) or CCRT alone (n = 162). Risk stratification into high-/low-risk subgroups utilized a published prognostic model. Kaplan-Meier estimates compared 10-year overall survival (OS), locoregional failure-free survival (LFFS), distant metastasis-free survival (DMFS), and failure-free survival (FFS).
RESULTS
The 10-year OS, DMFS, LFFS, and FFS rates for the entire cohort were 71.7 %, 81.4 %, 87.9 %, and 68.1 %, respectively. Compared to CCRT alone, CCRT + AC demonstrated no significant improvement in OS (70.9 % vs. 73.4 %; HR = 1.036, 95 % CI: 0.717-1.497, P = 0.849), LFFS (87.5 % vs. 88.7 %; HR = 1.176, 95 % CI: 0.642-2.154, P = 0.598), DMFS (79.4 % vs. 85.3 %; HR = 1.356, 95 % CI: 0.839-2.191, P = 0.211), or FFS (66.4 % vs. 71.5 %; HR = 1.133, 95 % CI: 0.803-1.599, P = 0.477). In high-risk patients, AC failed to enhance OS (62.7 % vs. 57.5 %; HR = 0.755, 95 % CI: 0.511-1.115, P = 0.156) or other survival endpoints. Notably, AC was associated with reduced OS (84.8 % vs. 94.1 %; HR = 3.319, 95 % CI: 0.966-11.401, P = 0.043) and FFS (77.8 % vs. 92.0 %; HR = 2.596, 95 % CI: 1.064-6.332, P = 0.029) in low-risk patients, while showing no benefit in LFFS or DMFS.
CONCLUSION
The addition of AC to CCRT did not improve 10-year survival outcomes in locoregionally advanced NPC. Moreover, AC may adversely impact survival in low-risk patients, highlighting the need for risk-adapted therapeutic strategies.
目的
评估调强放疗（IMRT）时代局部晚期鼻咽癌（NPC）患者接受同步放化疗（CCRT）±辅助化疗（AC）后的10年生存结局，并评估AC对高危和低危患者生存的影响。
方法
这项回顾性队列研究分析了477例非转移性NPC患者（2009 - 2012年），这些患者接受了CCRT + AC（n = 315）或单纯CCRT（n = 162）治疗。采用已发表的预后模型将患者分为高/低危亚组。Kaplan-Meier估计法比较了10年总生存率（OS）、局部区域无复发生存率（LFFS）、远处转移无复发生存率（DMFS）和无复发生存率（FFS）。
结果
整个队列的10年OS、DMFS、LFFS和FFS率分别为71.7%、81.4%、87.9%和68.1%。与单纯CCRT相比，CCRT + AC在OS（70.9%对73.4%；HR = 1.036，95%CI：0.717 - 1.497，P = 0.849）、LFFS（87.5%对88.7%；HR = 1.176，95%CI：0.642 - 2.154，P = 0.598）、DMFS（79.4%对85.3%；HR = 1.356，95%CI：0.839 - 2.191，P = 0.211）或FFS（66.4%对71.5%；HR = 1.133，95%CI：0.803 - 1.599，P = 0.477）方面均未显示出显著改善。在高危患者中，AC未能提高OS（62.7%对57.5%；HR = 0.755，95%CI：0.511 - 1.115，P = 0.156）或其他生存终点。值得注意的是，在低危患者中，AC与OS降低（84.8%对94.1%；HR = 3.319，95%CI：0.966 - 11.401，P = 0.043）和FFS降低（77.8%对92.0%；HR = 2.596，95%CI：1.064 - 6.332，P = 0.029）相关，而在LFFS或DMFS方面未显示出益处。
结论
CCRT联合AC并不能改善局部晚期NPC患者的10年生存结局。此外，AC可能对低危患者的生存产生不利影响，这凸显了采用风险适应性治疗策略的必要性。
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