N2～3期局部晚期鼻咽癌不同新辅助化疗疗程预后分析
|
摘要
目的探讨不同新辅助化疗(NCT)疗程对N2～3期局部晚期鼻咽癌的预后影响。方法回顾性分析2012—2013年收治的270例N2～3期局部晚期鼻咽癌行新辅助化疗+同步放化疗或单纯同步放化疗患者的一般临床资料,全组NCT≥3程、NCT=1～2程、NCT=0程患者分别为84例、106例和80例。Kaplan-Meier法计算生存率并行Logrank法检验,Cox单、多因素分析无远处转移生存影响因素。结果全组中位随访时间63月(6～75月)。全组5年总生存(5-OS)、无瘤生存(5-DFS)、无局部复发生存(5-LRFS)和无远处转移生存率(5-DMFS)分别为78.4%、77.8%、97.7%和79.5%。三组5-OS分别为88.1%、78.8%和73.5%(P=0.03);三组5-DFS分别为89.3%、74.0%和72.3%(P=0.021),三组5-DMFS分别为89.3%、76.6%和74.5%(P=0.031),三组5-LRFS差异无统计学意义(P=0.535);单、多因素分析提示新辅助化疗疗程、N分期、年龄均是治疗后有无转移的独立预后因素。结论N2～3期局部晚期鼻咽癌患者行NCT≥3程诱导化疗+同步放化疗可明显提高总生存期、降低远处转移率。
Objective To investigate and compare the prognostic effects of different courses of neoadjuvant chemotherapy(NCT) on patients with clinical stage N2-3 locally advanced nasopharyngeal carcinoma.Methods We retrospectively reviewed the clinical data of 270 patients with locally advanced nasopharyngeal carcinoma(cT1-4 N2-3) who were treated with NCT followed by concurrent chemoradiotherapy(CCRT) or only CCRT from 2012 to 2013. Patients were classified into three groups: NCT≥3(n=84, 31.1%), NCT=2(n=106, 39.3%) and NCT=0(n=80, 29.6%). The survival rate was calculated by Kaplan-Meier and examined by Log rank test. Univariate and multivariate analyses of the distant metastasis free survival(DMFS) factors was conducted using Cox proportional hazard models. Results The median follow-up time was 63 months(6-75 months). For the whole group, 5-year overall survival(5-OS), 5-year disease free survival(5-DFS),5-year local recurrence free survival(5-LRFS) and 5-year distant metastasis free survival(5-DMFS) were78.4%, 77.8%, 97.7% and 79.5%, respectively. For NCT≥3, NCT=1-2 and NCT=0 groups, 5-OS were 88.1%,78.8% and 73.5%, respectively(P=0.03); 5-DFS were 89.3%, 74.0% and 72.3%, respectively(P=0.021);5-DMFS were 89.3%, 76.6% and 74.5%, respectively(P=0.031); 5-LRFS had no statistically significant difference among the three groups(P=0.535). Univariate and multivariate analyses suggested that neoadjuvant chemotherapy course, N stage and age were all independent prognostic factors. Conclusion More than three courses of NCT before CCRT could improve overall survival and reduce distant metastases rate in stage N2-3 locally advanced nasopharyngeal carcinoma patients.
Objective To investigate and compare the prognostic effects of different courses of neoadjuvant chemotherapy(NCT) on patients with clinical stage N2-3 locally advanced nasopharyngeal carcinoma.Methods We retrospectively reviewed the clinical data of 270 patients with locally advanced nasopharyngeal carcinoma(cT1-4 N2-3) who were treated with NCT followed by concurrent chemoradiotherapy(CCRT) or only CCRT from 2012 to 2013. Patients were classified into three groups: NCT≥3(n=84, 31.1%), NCT=2(n=106, 39.3%) and NCT=0(n=80, 29.6%). The survival rate was calculated by Kaplan-Meier and examined by Log rank test. Univariate and multivariate analyses of the distant metastasis free survival(DMFS) factors was conducted using Cox proportional hazard models. Results The median follow-up time was 63 months(6-75 months). For the whole group, 5-year overall survival(5-OS), 5-year disease free survival(5-DFS),5-year local recurrence free survival(5-LRFS) and 5-year distant metastasis free survival(5-DMFS) were78.4%, 77.8%, 97.7% and 79.5%, respectively. For NCT≥3, NCT=1-2 and NCT=0 groups, 5-OS were 88.1%,78.8% and 73.5%, respectively(P=0.03); 5-DFS were 89.3%, 74.0% and 72.3%, respectively(P=0.021);5-DMFS were 89.3%, 76.6% and 74.5%, respectively(P=0.031); 5-LRFS had no statistically significant difference among the three groups(P=0.535). Univariate and multivariate analyses suggested that neoadjuvant chemotherapy course, N stage and age were all independent prognostic factors. Conclusion More than three courses of NCT before CCRT could improve overall survival and reduce distant metastases rate in stage N2-3 locally advanced nasopharyngeal carcinoma patients.
引文
[1]Tan IB,Chang ET,Chen C,et al.Proceedings of the 7th Biannual International Symposium on Nasopharyngeal Carcinoma 2015:Yogyakarta,Indonesia.4-6 June 2015[J].BMC Proc,2016,10(Suppl 1):1.
[2]Sung SY,Kang MK,Kay CS,et al.Patterns of care for patients with nasopharyngeal carcinoma(KROG 11-06)in South Korea[J].Radiat Oncol J,2015,33(3):188-97.
[3]Qiu WZ,Huang PY,Shi JL,et al.Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma:a retrospective controlled study[J].Chin J Cancer,2016,35:2.
[4]Xu JH,Guo WJ,Bian XH,et al.A comparative study of locoregionally advanced nasopharyngeal carcinoma treated with intensity modulated irradiation and platinum-based chemotherapy[J].Cancer Radiother,2013,17(4):297-303.
[5]Zeng L,Tian YM,Sun XM,et al.Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma:clinical outcomes and patterns of failure in an endemic area in China[J].Strahlenther Onkol,2014,190(11):993-1000.
[6]Colevas AD,Yom SS,Pfister DG,et al.NCCN Guidelines Insights:Head and Neck Cancers,Version 1.2018[J].J Natl Compr Canc Netw,2018,16(5):479-90.
[7]Sun Y,Li WF,Chen NY,et al.Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomised controlled trial[J].Lancet Oncol,2016,17(11):1509-20.
[8]Cao SM,Yang Q,Guo L,et al.Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:A phaseⅢmulticentre randomised controlled trial[J].Eur J Cancer,2017,75:14-23.
[9]Lee AW,Ngan RK,Tung SY,et al.Preliminary results of trial NPC-0501 evaluating the therapeutic gain by changing from concurrent-adjuvant to induction-concurrent chemoradiotherapy,changing from fluorouracil to capecitabine,and changing from conventional to accelerated radiotherapy fractionation in patients with locoregionally advanced nasopharyngeal carcinoma[J].Cancer,2015,121(8):1328-38.
[10]Ribassin-Majed L,Marguet S,Lee AWM,et al.What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma?An Individual Patient Data Network Meta-Analysis[J].J Clin Oncol,2017,35(5):498-505.
[11]Chen YP,Guo R,Liu N,et al.Efficacy of the Additional Neoadjuvant Chemotherapy to Concurrent Chemoradiotherapy for Patients with Locoregionally Advanced Nasopharyngeal Carcinoma:a Bayesian Network Meta-analysis of Randomized Controlled Trials[J].J Cancer,2015,6(9):883-92.
[12]Setakornnukul J,Thephamongkhol K.Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma[J].BMC Cancer,2018,18(1):329.
[13]Mak HW,Lee SH,Chee J,et al.Clinical Outcome among Nasopharyngeal Cancer Patients in a Multi-Ethnic Society in Singapore[J].PLoS One,2015,10(5):e0126108.
[14]Chen X,Long X,Liang Z,et al.Higher N stage and serum ferritin,but lower serum albumin levels are associated with distant metastasis and poor survival in patients with nasopharyngeal carcinoma following intensity-modulated radiotherapy[J].Oncotarget,2017,8(42):73177-86.
[15]Chen CY,Han F,Zhao C,et al.Treatment results and late complications of 556 patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone[J].Br JRadiol,2009,82(978):452-8.
[16]Yin L,Bian X,Wang X,et al.Long-Term Results of Concurrent Chemoradiotherapy for Advanced N2-3 Stage Nasopharyngeal Carcinoma[J].PLoS One,2015,10(9):e137383.
[17]Kawahira M,Yokota T,Hamauchi S,et al.Survival benefit of adding docetaxel,cisplatin,and 5-fluorouracil induction chemotherapy to concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma with nodal Stage N2-3[J].Jpn J Clin Oncol,2017,47(8):705-12.
[18]魏嘉旺,黄蓉,余昕,等.3~4周期NACT对N2-N3期鼻咽癌临床价值分析[J].中华放射肿瘤学杂志,2017,26(4):380-3.[Wei JW,Huang R,Yu X,et al.Impact of three to four cycles of neoadjuvant chemotherapy on survival of patients with N2-N3nasopharyngeal carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2017,26(4):380-3.]
[19]Tang LQ,Chen DP,Guo L,et al.Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma:an open-label,non-inferiority,randomised phase 3trial[J].Lancet Oncol,2018,19(4):461-73.
[2]Sung SY,Kang MK,Kay CS,et al.Patterns of care for patients with nasopharyngeal carcinoma(KROG 11-06)in South Korea[J].Radiat Oncol J,2015,33(3):188-97.
[3]Qiu WZ,Huang PY,Shi JL,et al.Neoadjuvant chemotherapy plus intensity-modulated radiotherapy versus concurrent chemoradiotherapy plus adjuvant chemotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma:a retrospective controlled study[J].Chin J Cancer,2016,35:2.
[4]Xu JH,Guo WJ,Bian XH,et al.A comparative study of locoregionally advanced nasopharyngeal carcinoma treated with intensity modulated irradiation and platinum-based chemotherapy[J].Cancer Radiother,2013,17(4):297-303.
[5]Zeng L,Tian YM,Sun XM,et al.Intensity-modulated radiotherapy for stage IVA/IVB nasopharyngeal carcinoma:clinical outcomes and patterns of failure in an endemic area in China[J].Strahlenther Onkol,2014,190(11):993-1000.
[6]Colevas AD,Yom SS,Pfister DG,et al.NCCN Guidelines Insights:Head and Neck Cancers,Version 1.2018[J].J Natl Compr Canc Netw,2018,16(5):479-90.
[7]Sun Y,Li WF,Chen NY,et al.Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:a phase 3,multicentre,randomised controlled trial[J].Lancet Oncol,2016,17(11):1509-20.
[8]Cao SM,Yang Q,Guo L,et al.Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma:A phaseⅢmulticentre randomised controlled trial[J].Eur J Cancer,2017,75:14-23.
[9]Lee AW,Ngan RK,Tung SY,et al.Preliminary results of trial NPC-0501 evaluating the therapeutic gain by changing from concurrent-adjuvant to induction-concurrent chemoradiotherapy,changing from fluorouracil to capecitabine,and changing from conventional to accelerated radiotherapy fractionation in patients with locoregionally advanced nasopharyngeal carcinoma[J].Cancer,2015,121(8):1328-38.
[10]Ribassin-Majed L,Marguet S,Lee AWM,et al.What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma?An Individual Patient Data Network Meta-Analysis[J].J Clin Oncol,2017,35(5):498-505.
[11]Chen YP,Guo R,Liu N,et al.Efficacy of the Additional Neoadjuvant Chemotherapy to Concurrent Chemoradiotherapy for Patients with Locoregionally Advanced Nasopharyngeal Carcinoma:a Bayesian Network Meta-analysis of Randomized Controlled Trials[J].J Cancer,2015,6(9):883-92.
[12]Setakornnukul J,Thephamongkhol K.Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma[J].BMC Cancer,2018,18(1):329.
[13]Mak HW,Lee SH,Chee J,et al.Clinical Outcome among Nasopharyngeal Cancer Patients in a Multi-Ethnic Society in Singapore[J].PLoS One,2015,10(5):e0126108.
[14]Chen X,Long X,Liang Z,et al.Higher N stage and serum ferritin,but lower serum albumin levels are associated with distant metastasis and poor survival in patients with nasopharyngeal carcinoma following intensity-modulated radiotherapy[J].Oncotarget,2017,8(42):73177-86.
[15]Chen CY,Han F,Zhao C,et al.Treatment results and late complications of 556 patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone[J].Br JRadiol,2009,82(978):452-8.
[16]Yin L,Bian X,Wang X,et al.Long-Term Results of Concurrent Chemoradiotherapy for Advanced N2-3 Stage Nasopharyngeal Carcinoma[J].PLoS One,2015,10(9):e137383.
[17]Kawahira M,Yokota T,Hamauchi S,et al.Survival benefit of adding docetaxel,cisplatin,and 5-fluorouracil induction chemotherapy to concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma with nodal Stage N2-3[J].Jpn J Clin Oncol,2017,47(8):705-12.
[18]魏嘉旺,黄蓉,余昕,等.3~4周期NACT对N2-N3期鼻咽癌临床价值分析[J].中华放射肿瘤学杂志,2017,26(4):380-3.[Wei JW,Huang R,Yu X,et al.Impact of three to four cycles of neoadjuvant chemotherapy on survival of patients with N2-N3nasopharyngeal carcinoma[J].Zhonghua Fang She Zhong Liu Xue Za Zhi,2017,26(4):380-3.]
[19]Tang LQ,Chen DP,Guo L,et al.Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma:an open-label,non-inferiority,randomised phase 3trial[J].Lancet Oncol,2018,19(4):461-73.