Chen Jie, Cheng Hui, Li Yi-Fu, Li Yu-Chen, Long Hao-Xiang, Lin Jie-Yi, Tse Chun Fung, Shen Bo-Wen, Wang Pan, Liu Sai-Lan, Guo Shan-Shan, Liang Shu-Ming, Chen Qiu-Yan, Tang Lin-Quan, Mai Hai-Qiang, Liu Li-Ting
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, Guangdong, China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
BMJ Oncol. 2025 Jul 21;4(1):e000718. doi: 10.1136/bmjonc-2024-000718. eCollection 2025.
This study aimed to evaluate the efficacy and toxicity of various adjuvant chemotherapy (AC) regimens for treating locoregionally advanced nasopharyngeal carcinoma.
In this retrospective study, the patients received either intravenous AC regimens (cisplatin-fluorouracil (PF) or cisplatin-gemcitabine (GP)) or oral regimens (capecitabine or tegafur, gimeracil and oteracil potassium capsule (S-1)) following concurrent chemoradiotherapy (CCRT). The primary endpoint was progression-free survival (PFS).
A total of 229 patients were documented in the oral administration group (127 patients received capecitabine and 102 received S-1), whereas 241 patients were recorded in the intravenous group (164 patients received the PF regimen and 77 received the GP regimen). There was no significant difference in PFS between the intravenous and oral groups (n=154 each) after propensity score matching (3-year PFS rate: 76.3% vs 73.9%; HR, 0.803; 95% CI 0.523 to 1.233, p=0.316). However, based on the overall cohort, the GP regimen showed a superior 3-year PFS rate (89.1%) compared with PF (74.6%), capecitabine (76.0%) and S-1 (74.3%) regimen (p=0.005, 0.012 and 0.003, respectively), while multivariable analyses also demonstrated that the GP regimen (HR, 0.38; 95% CI 0.18 to 0.81, p=0.012) was associated with better survival. Additionally, the intravenous group, which included PF and GP, exhibited a higher incidence of grade≥3 leucocytopenia (50.0% vs 22.7%), neutropenia (30.5% vs 18.2%), anaemia (16.2% vs 3.9%), hyponatraemia (3.2% vs 0) and hypokalaemia (12.3% vs 4.5%) than the oral group.
For patients treated with upfront CCRT, AC should be considered, and intravenous GP is preferred, although patients should be counselled about an increased risk of haematological toxicities. For patients treated with induction chemotherapy and CCRT, oral chemotherapy, either with capecitabine or S-1, was efficacious and tolerable.
本研究旨在评估各种辅助化疗（AC）方案治疗局部晚期鼻咽癌的疗效和毒性。
在这项回顾性研究中，患者在同步放化疗（CCRT）后接受静脉AC方案（顺铂-氟尿嘧啶（PF）或顺铂-吉西他滨（GP））或口服方案（卡培他滨或替加氟、吉美嘧啶和奥替拉西钾胶囊（S-1））。主要终点是无进展生存期（PFS）。
口服给药组共记录了229例患者（127例接受卡培他滨，102例接受S-1），而静脉给药组记录了241例患者（164例接受PF方案，77例接受GP方案）。倾向得分匹配后，静脉给药组和口服给药组（每组n = 154）的PFS无显著差异（3年PFS率：76.3%对73.9%；HR，0.803；95%CI 0.523至1.233，p = 0.316）。然而，基于整个队列，与PF（74.6%）、卡培他滨（76.0%）和S-1（74.3%）方案相比，GP方案显示出更高的3年PFS率（89.1%）（p分别为0.005、0.012和0.003），而多变量分析也表明GP方案（HR，0.38；95%CI 0.18至0.81，p = 0.012）与更好的生存率相关。此外，包括PF和GP的静脉给药组≥3级白细胞减少症（50.0%对22.7%）、中性粒细胞减少症（30.5%对18.2%）、贫血（16.2%对3.9%）、低钠血症（3.2%对0）和低钾血症（12.3%对4.5%）的发生率高于口服给药组。
对于接受 upfront CCRT 治疗的患者，应考虑进行AC，尽管应告知患者血液学毒性风险增加，但静脉注射GP是首选。对于接受诱导化疗和CCRT治疗的患者，口服化疗，无论是使用卡培他滨还是S-1，都是有效且可耐受的。
