Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on induction chemotherapy response
Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on induction chemotherapy response
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基于诱导化疗反应的鼻咽癌患者顺铂最佳累积剂量
DOI：
10.1016/j.radonc.2019.04.020
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发表时间：
2019-08-01
影响因子：
5.7
通讯作者：
Mai, Hai-Qiang
中科院分区：
文献类型：
--
作者：
Liu, Sai-Lan;Sun, Xue-Song;Mai, Hai-Qiang
背景和目的：根据诱导化疗（IC）的肿瘤反应，鼻咽癌（NPC）患者可分为两个危险亚组。我们的目的是阐明最佳的累积顺铂剂量（CCD）的同步放化疗（CCRT）为不同的NPC患者subgroup.Participants和方法：共990例事件NPC诊断之间的2008年和2017年治疗IC加CCRT纳入我们的观察性研究。采用卡方检验或Fisher精确检验比较不同肿瘤缓解患者的临床病理特征。采用多变量考克斯比例风险模型评估预后。结果：IC后，990例患者中有761例（76.9%）患者肿瘤完全缓解（CR）/部分缓解（PR），229例（23.1%）患者疾病稳定（SD）/疾病进展（PD）。IC后不满意的肿瘤缓解（SD/PD）与不良临床结局相关（3年PFS 61.4% vs. 83.2%，P < 0.001，3年LRFS 80.9% vs. 94.5%，P < 0.001）。IC后达到CR/PR的患者接受CCD > 200 mg/m2，3年PFS和DMFS率高于接受CCD < 100 mg/m2的患者（PFS：85.4% vs. 77.9%，P = 0.045; DMFS：89.4% vs. 77.9%，P = 0.015）。多因素分析显示，在CR/PR亚组中，CCD是PFS和DMFS的独立预后因素。此外，中剂量组显示与高剂量组相似的疗效，但与较少的1-4级急性毒性相关。结论：IC治疗鼻咽癌的疗效是影响鼻咽癌患者预后的独立因素。对于IC后达到CR/PR的患者，与接受低CCD的患者相比，接受高CCD的患者显示3年PFS和DMFS显著改善。平衡毒性和疗效，200 mg/m2似乎是CR/PR组的最佳剂量。然而，CCD的增强并没有为IC后达到SD/PD的患者提供生存获益，这些患者的治疗选择需要进一步考虑。(C)2019由Elsevier B. V.出版
Background and purpose: Nasopharyngeal carcinoma (NPC) patients can be separated into two risk subgroups according to tumor responses to induction chemotherapy (IC). We aimed to elucidate the optimal cumulative cisplatin dose (CCD) of concurrent chemoradiotherapy (CCRT) for different NPC patient subgroups.Participants and methods: A total of 990 patients with incident NPC diagnosed between 2008 and 2017 treated with IC plus CCRT were included in our observational study. The clinicopathological features of patients with different tumor responses were compared using the Chi-square test or Fisher's exact test. Prognosis was assessed using a multivariate Cox proportional hazards model. In addition, acute and late toxicities were compared between different CCD groups.Results: After IC, 761/990 (76.9%) patients had a complete tumor response (CR)/partial response (PR) and 229 (23.1%) had stable disease (SD)/disease progression (PD). An unsatisfactory tumor response (SD/PD) after IC correlated with poor clinical outcome (3-year PFS 61.4% vs. 83.2%, P < 0.001 and 3-year LRFS 80.9% vs. 94.5%, P < 0.001). Patients who achieved CR/PR after IC received a CCD > 200 mg/m(2) and showed higher 3-year PFS and DMFS rates than those receiving a CCD < 100 mg/m(2) (PFS: 85.4% vs. 77.9%, P = 0.045; DMFS: 89.4% vs. 77.9%, P = 0.015). Multivariate analysis also showed that CCD was an independent prognostic factor for PFS and DMFS in CR/PR subgroup. Moreover, the medium dose group showed similar efficacy as high dose group but was associated with fewer grade 1-4 acute toxicities. However, application of different CCD didn't result in significantly different survival outcomes in SD/PD subgroup.Conclusions: Tumor response to IC was an independent prognostic factor for patients with NPC. For the patients who achieved CR/PR after IC, patients receiving high CCD showed significantly improved 3 year PFS and DMFS compared with patients receiving low CCD. Balancing toxicity and efficacy, 200 mg/m(2) seemed to be the optimal dose in the CR/PR groups. However, enhancement of CCD did not provide survival benefit for patients who achieved SD/PD after IC, and treatment options for these patients require further consideration. (C) 2019 Published by Elsevier B.V.