Concurrent Chemoradiotherapy versus Intensity-modulated Radiotherapy Alone for Elderly Nasopharyngeal Carcinoma Patients with Pre-treatment Epstein-Barr Virus DNA: A Cohort Study in an Endemic Area with Long-term Follow-up.
Concurrent Chemoradiotherapy versus Intensity-modulated Radiotherapy Alone for Elderly Nasopharyngeal Carcinoma Patients with Pre-treatment Epstein-Barr Virus DNA: A Cohort Study in an Endemic Area with Long-term Follow-up.
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同步放化疗与单独调强放疗对治疗前携带 Epstein-Barr 病毒 DNA 的老年鼻咽癌患者的比较：流行区长期随访的队列研究
DOI：
10.7150/jca.26145
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发表时间：
2018
影响因子：
3.9
通讯作者：
Xia WX
中科院分区：
文献类型：
--
作者：
Yang Q;Zhao TT;Qiang MY;Hu L;Lv X;Ye YF;Ke LR;Yu YH;Qiu WZ;Liu GY;Huang XJ;Li WZ;Lv SH;Sun Y;Zhang LY;Pei F;Guo X;Xiang YQ;Qian CN;Huang BJ;Xia WX
目的：迄今为止，由于缺乏前瞻性临床试验，尚无针对老年鼻咽癌（NPC）患者（60岁或以上）的指南。本研究评估了同步化疗（CCRT）治疗高龄鼻咽癌患者调强放疗（IMRT）的疗效。方法：从前瞻性维护的数据库中确定患者。回顾性分析2002年1月至2013年12月连续行IMRT治疗的198例老年鼻咽癌患者，其中IMRT联合CCRT治疗103例，单独IMRT治疗95例。采用Cox比例风险模型和倾向评分分析（PSA）对总生存期（OS）和无病生存期（DFS）进行多变量分析（MVA）。最后进行敏感性分析。结果：中位随访时间为55.3个月（范围3 ~ 135.6个月）。在整个队列中，MVA和PSA模型均显示，与单独IMRT相比，IMRT加CCRT显著提高了生存率（风险比[HR] 2.143, 95%可信区间[95% CI] 1.180-3.890；风险比[HR] 1.961, 95% CI分别为1.117-3.443）。在eb病毒（EBV） DNA水平高的亚组中也发现了类似的结果，但EBV-DNA水平低的队列除外。严重急性毒性的总发生率，包括白细胞减少、中性粒细胞减少、口炎和呕吐，IMRT+CCRT组显著高于单独IMRT组（P < 0.001），但与严重晚期毒性发生率相似（P = 0.818）。敏感性分析证实了我们分析的稳健性。结论：在IMRT时代，对于老年鼻咽癌患者，高EBV DNA水平的CCRT保留了生存益处，而低EBV DNA水平的CCRT则没有。需要随机临床试验来证实我们的发现。
Purpose: To date, no guidelines exist for elderly nasopharyngeal carcinoma (NPC) patients (60 years of age or older) due to a lack of prospective clinical trials. This study evaluated the efficacy of concurrent chemotherapy (CCRT) for NPC in elderly patients treated with intensity-modulated radiotherapy (IMRT). Methods: Patients were identified from a prospectively maintained database. A total of 198 consecutive cases of elderly patients with NPC receiving IMRT, including 103 patients treated with IMRT plus CCRT and 95 patients treated with IMRT alone, were analysed from January 2002 to December 2013. Multivariate analysis (MVA) using the Cox proportional hazards model and propensity score analysis (PSA) were performed for overall survival (OS) and disease-free survival (DFS). Finally, sensitivity analysis was performed. Results: The median follow-up time was 55.3 months (range, 3-135.6 months). In the entire cohort, both MVA and PSA models showed that compared with IMRT alone, IMRT plus CCRT significantly improved survival (hazard ratio [HR] 2.143, 95% confidence interval [95% CI] 1.180-3.890; HR 1.961, 95% CI, 1.117-3.443, for OS and DFS, respectively). Similar results were found in the subgroups with high levels of Epstein-Barr virus (EBV) DNA, except in the low-EBV-DNA cohort. The total rates of severe acute toxicity, including leukopenia, neutropenia, stomatitis, and emesis, were significantly higher in the IMRT+CCRT group than in the IMRT-alone group (P < 0.001) but were similar to the rates of severe late toxicity (P = 0.818). Sensitivity analysis confirmed the robustness of our analysis. Conclusions: In the era of IMRT, CCRT retained survival benefits at high EBV DNA levels but not at low EBV DNA levels for elderly NPC patients. Randomized clinical trials are needed to confirm our findings.
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影响因子：
--
作者：
Sarmiento MP;Mejia MB
通讯作者：
Mejia MB
影响因子：
3.7
作者：
Cao CN;Luo JW;Gao L;Yi JL;Huang XD;Wang K;Zhang SP;Qu Y;Li SY;Xiao JP;Zhang Z;Xu GZ
通讯作者：
Xu GZ
影响因子：
51.1
作者：
Chen, Lei;Hu, Chao-Su;Ma, Jun
通讯作者：
Ma, Jun
影响因子：
0.8
作者：
Wang, CY
通讯作者：
Wang, CY
影响因子：
5.7
作者：
Sun, Xueming;Su, Shengfa;Lu, Taixiang
通讯作者：
Lu, Taixiang