Induction Chemotherapy Improved Long-term Outcomes of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Analysis of 5-year Survival Outcomes in the Era of Intensity-modulated Radiotherapy.
Induction Chemotherapy Improved Long-term Outcomes of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Analysis of 5-year Survival Outcomes in the Era of Intensity-modulated Radiotherapy.
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DOI：
10.7150/jca.16732
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发表时间：
2017
影响因子：
3.9
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Peng H;Chen L;Zhang J;Li WF;Mao YP;Zhang Y;Liu LZ;Tian L;Lin AH;Sun Y;Ma J
背景：本研究的目的是评估调强放疗（IMRT）时代诱导化疗（IC）对局部晚期鼻咽癌（NPC）的长期治疗效果。方法：回顾性分析957例接受IMRT治疗的T1-2N2-3或T3-4N1-3期鼻咽癌患者的数据。采用倾向得分匹配（PSM）方法来平衡各个协变量的影响。比较了 IC 组和非 IC 组之间的患者生存率。结果：通过PSM从最初的957例患者中筛选出318对，中位随访时间为57.13个月（范围1.27-78.1个月）。 IC组与非IC组的5年总生存率（OS）、无远处转移生存率（DMFS）、无病生存率（DFS）和局部无复发生存率（LRRFS）分别为87.2% vs. 80.8%（P = 0.023）、88.1% vs. 83.2%（P = 0.071）、80.7% vs.分别为 71.4% (P = 0.011) 和 92.1% vs. 86.7% (P = 0.081)。多变量分析确定 IC 是 OS（HR，0.595；95% CI，0.397-0.891；P = 0.012）和 DFS（HR，0.627；95% CI，0.451-0.872；P = 0.006）的独立预后因素。排除未接受同步化疗的患者后，发现IC是OS（HR，0.566；95% CI，0.368-0.872；P = 0.01）、DMFS（HR，0.580；95% CI，0.367-0.916；P = 0.02）和DFS（HR，0.633；P = 0.02）的独立预后因素。 95% CI，0.444-0.903；P = 0.012）。结论：IC对于T1-2N2-3期和T3-4N1-3期鼻咽癌患者是一种有效的治疗方式，IC与标准CCRT的结合可以取得最佳的治疗效果。
Background: The aim of this study is to evaluate the long-term therapeutic gain of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). Methods: Data on 957 patients with stage T1-2N2-3 or T3-4N1-3 NPC treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance influence of various covariates. Patient survival between IC and non-IC groups were compared. Results: For the 318 pairs selected from the original 957 patients by PSM, the median follow-up duration was 57.13 months (range, 1.27-78.1 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and locoregional relapse-free survival (LRRFS) rates for IC group vs. non-IC group were 87.2% vs. 80.8% (P = 0.023), 88.1% vs. 83.2% (P = 0.071), 80.7% vs. 71.4% (P = 0.011) and 92.1% vs. 86.7% (P = 0.081), respectively. Multivariate analysis identify IC as an independent prognostic factor for OS (HR, 0.595; 95% CI, 0.397-0.891; P = 0.012) and DFS (HR, 0.627; 95% CI, 0.451-0.872; P = 0.006). After excluding the patients not receiving concurrent chemotherapy, IC was found to be an independent prognostic factor for OS (HR, 0.566; 95% CI, 0.368-0.872; P = 0.01), DMFS (HR, 0.580; 95% CI, 0.367-0.916; P = 0.02) and DFS (HR, 0.633; 95% CI, 0.444-0.903; P = 0.012). Conclusions: IC is an effective treatment modality for patients with stage T1-2N2-3 and T3-4N1-3 NPC, and the incorporation of IC with standard CCRT could achieve the best therapeutic gain.