Neoadjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: Defining high-risk patients who may benefit before concurrent chemotherapy combined with intensity-modulated radiotherapy.
Neoadjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: Defining high-risk patients who may benefit before concurrent chemotherapy combined with intensity-modulated radiotherapy.
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DOI：
10.1038/srep16664
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发表时间：
2015-11-13
影响因子：
4.6
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Du XJ;Tang LL;Chen L;Mao YP;Guo R;Liu X;Sun Y;Zeng MS;Kang TB;Shao JY;Lin AH;Ma J
本研究的目的是建立一个局部晚期鼻咽癌患者接受同步化疗联合调强放疗（CCRT）的远处转移的预后模型，以确定可能受益于新辅助化疗（NACT）的高危患者。回顾性分析了881例新诊断的、非播散性的、活检证实的局部晚期NPC患者; 411例（46.7%）接受了CCRT，470例（53.3%）接受了NACT，随后接受了CCRT。多因素分析显示N2-3期、血浆EB病毒DNA > 4000 copies/mL、血清白蛋白≤46 g/L、血小板计数>300 k/cc是CCRT组远处转移的独立预后因素。使用这四个因素，建立了一个预后模型，如下：1）低风险组：0-1个风险因素; 2）高风险组：2-4个风险因素。在高危组中，接受NACT + CCRT的患者的无远处转移生存率和无进展生存率显著高于CCRT组（P = 0.001; P = 0.011）。这种局部晚期鼻咽癌远处转移的简单预后模型可能有助于选择在CCRT之前可能受益于NACT的高危患者。
The purpose of this study was to create a prognostic model for distant metastasis in patients with locally advanced NPC who accept concurrent chemotherapy combined with intensity-modulated radiotherapy (CCRT) to identify high-risk patients who may benefit from neoadjuvant chemotherapy (NACT). A total of 881 patients with newly-diagnosed, non-disseminated, biopsy-proven locoregionally advanced NPC were retrospectively reviewed; 411 (46.7%) accepted CCRT and 470 (53.3%) accepted NACT followed by CCRT. Multivariate analysis demonstrated N2–3 disease, plasma Epstein–Barr virus (EBV) DNA > 4000 copies/mL, serum albumin ≤46 g/L and platelet count >300 k/cc were independent prognostic factors for distant metastasis in the CCRT group. Using these four factors, a prognostic model was developed, as follows: 1) low-risk group: 0–1 risk factors; and 2) high-risk group: 2–4 risk factors. In the high-risk group, patients who accepted NACT + CCRT had significantly higher distant metastasis-free survival and progression-free survival rates than the CCRT group (P = 0.001; P = 0.011). This simple prognostic model for distant metastasis in locoregionally advanced NPC may facilitate with the selection of high-risk patients who may benefit from NACT prior to CCRT.