Impact of prior cancer on outcomes in nasopharyngeal carcinoma
Impact of prior cancer on outcomes in nasopharyngeal carcinoma
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既往癌症对鼻咽癌预后的影响
DOI：
10.21037/atm.2019.05.78
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发表时间：
2019-07-01
影响因子：
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通讯作者：
Zhang, Li
中科院分区：
文献类型：
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作者：
Zhou, Huaqiang;Zhang, Yaxiong;Zhang, Li
背景：既往癌症是鼻咽癌（NPC）试验中常见的排除标准。然而，先前的癌症诊断是否会影响试验结果仍然是未知的。我们的目的是确定以前的癌症对生存的影响在NPC patients.Methods：我们确定了2004年和2009年之间的监测，流行病学和最终结果（SEER）数据库中诊断为鼻咽癌的患者。适当时，通过卡方检验和t检验比较变量。采用Kaplan-Meier法和考克斯比例风险模型评估既往癌症对总生存期（OS）的影响。结果：在3,131例符合条件的NPC患者中，349例（11.15%）有既往癌症史。Kaplan-Meier曲线未显示统计学显著差异的OS（P=0.19）。亚组分析显示了相同的趋势：与无既往癌症的患者相比，既往癌症对OS没有不利影响（P>0.05）。此外，在倾向评分调整的考克斯模型分析中，既往癌症患者具有相同/非劣效OS [风险比（HR）= 1.12; 95%置信区间，0.88至1.42]。结论：在NPC患者中，既往癌症不会对临床结局产生不良影响，无论既往癌症的时间和指数癌症的AJCC TNM分期如何。在有既往癌症史的NPC患者中可以采用更广泛的纳入试验标准。然而，仍需要进一步的研究来证实这一结论。
Background: Prior cancer is a common exclusion criterion in nasopharyngeal carcinoma (NPC) trials. However, whether a prior cancer diagnosis affects trial outcomes is still unknown. We aimed to determine the impact of prior cancer on survival in NPC patients.Methods: We identified patients diagnosed with NPC between 2004 and 2009 in the Surveillance, Epidemiology, and End Results (SEER) database. Variables were compared by chi-squared test and t-test as appropriate. Propensity score-adjusted Kaplan-Meier methods and Cox proportional hazard models were used to evaluate the impact of prior cancer on overall survival (OS).Results: Among 3,131 eligible NPC patients, 349 (11.15%) patients had a history of prior cancer. The Kaplan-Meier curves did not show a statistically significantly different OS (P=0.19). Subgroup analyses stratified by timing of prior cancer and AJCC TNM stage of index cancer displayed the same tendency: prior cancer did not adversely affect OS compared to patients without prior cancer (P>0.05). Furthermore, in propensity score-adjusted COX models analysis, patients with prior cancer had the same/non-inferior OS [hazard ratio (HR) = 1.12; 95% confidence interval, 0.88 to 1.42].Conclusions: Among patients with NPC, prior cancer does not convey an adverse effect on clinical outcomes, regardless of the timing of prior cancer and AJCC TNM stage of index cancer. Broader inclusion trial criteria could be adopted in NPC patients with a history of prior cancer. However, further studies are still needed to confirm this conclusion.