Induction Chemotherapy Has No Prognostic Value in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma and Chronic Hepatitis B Infection in the IMRT Era.
Induction Chemotherapy Has No Prognostic Value in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma and Chronic Hepatitis B Infection in the IMRT Era.
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IMRT时代诱导化疗对局部晚期鼻咽癌合并慢性乙型肝炎感染患者没有预后价值
DOI：
10.1016/j.tranon.2017.07.001
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发表时间：
2017-10
影响因子：
5
通讯作者：
Sun Y
中科院分区：
文献类型：
--
作者：
Zhang LL;Zhou GQ;Li YC;Lin AH;Ma J;Qi ZY;Sun Y
背景技术背景：在调强放疗（IMRT）时代，诱导化疗（IC）后同步放化疗（CCRT）相对于单纯CCRT治疗局部晚期鼻咽癌（NPC）和慢性乙型肝炎（B）感染患者的有效性尚不清楚。患者和方法：回顾性分析了249例接受调强放射治疗的T1-2、N2-3或T3-4、N1-3期鼻咽癌合并慢性B型肝炎患者。采用倾向评分匹配（PSM）来平衡协变量; 140例患者进行了倾向匹配（1：1基础）。采用Kaplan-Meier法、对数秩检验和考克斯比例风险模型比较IC + CCRT组和CCRT组的生存结局。研究结果：IC + CCRT和CCRT之间未观察到显著的生存差异（5年总生存率，88.3% vs. 82.2%; P = .484;无病生存率，73.9% vs. 75.2%; P = .643;无远处转移生存率，84.1% vs. 85.1%; P = .781;局部无失败生存率分别为87.9%和85.1%; P = 0.834）。在多变量分析中调整已知的预后因素后，IC不是任何预后的独立预后因素（所有P > 0.05）;基于T分类（T1-2/T3-4），N分类（N 0 -1/N2-3）和总体分期（III/IV）的亚组分析证实了这些结果。IC + CCRT组与CCRT组肝功能损害的发生率无显著差异。结论：在IMRT时代，IC + CCRT导致局部晚期NPC伴慢性B型肝炎感染患者的生存结局和肝功能损害与单独CCRT相当。需要进一步调查。
BACKGROUND: The effectiveness of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) over CCRT alone in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and chronic hepatitis B infection in the intensity-modulated radiotherapy (IMRT) era is unknown. PATIENTS AND METHODS: A total of 249 patients with stage T1-2 N2-3 or T3-4 N1-3 NPC and chronic hepatitis B infection treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) was employed to balance covariates; 140 patients were propensity-matched (1:1 basis). Survival outcomes in the IC + CCRT and CCRT groups were compared using the Kaplan–Meier method, log-rank test and Cox proportional hazards model. RESULTS: No significant survival differences were observed between IC + CCRT and CCRT (5-year overall survival, 88.3% vs. 82.2%; P = .484; disease-free survival, 73.9% vs. 75.2%; P = .643; distant metastasis-free survival, 84.1% vs. 85.1%; P = .781; and locoregional failure-free survival, 87.9% vs. 85.1%; P = .834). After adjusting for known prognostic factors in multivariate analysis, IC was not an independent prognostic factor for any outcome (all P > .05); subgroup analysis based on T category (T1-2/T3-4), N category (N0-1/N2-3), and overall stage (III/IV) confirmed these results. The incidence of hepatic function damage in the IC + CCRT and CCRT groups was not significantly different. CONCLUSION: IC + CCRT leads to comparable survival outcomes and hepatic function damage compared to CCRT alone in patients with locoregionally advanced NPC with chronic hepatitis B infection in the IMRT era. Further investigations are warranted.
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