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Selection and validation of chemotherapy beneficiaries among elderly nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT): a large real-world study

鼻咽癌 医学 内科学 放化疗 放射治疗 肿瘤科 化疗 阶段(地层学) 危险分层 诱导化疗 胃肠病学 生物 古生物学
作者
Yanling Wu,Kai‐Bin Yang,Ying Huang,Jingrong Shi,Qing-Shui He,Lei Chen,Wenfei Li,Xiao-Dan Huang,Lin Li,Yu-Pei Chen,Yan‐Ping Mao,Ling‐Long Tang,Jun Ma
出处
期刊:Radiation Oncology [Springer Nature]
卷期号:17 (1) 被引量:4
标识
DOI:10.1186/s13014-022-02095-2
摘要

Abstract Purpose Using real-world evidence, this study aimed to identify elderly nasopharyngeal carcinoma (NPC) patients who would benefit from chemotherapy. Methods and materials 1714 elderly NPC patients between April 2007 and December 2017 were identified. Recursive partitioning analysis (RPA) was used to generate risk-stratified outcomes. Prognostic factors were performed for individual comparisons of different risk groups to assess chemotherapy benefits. Results The median follow-up was 59.3 (0.39–170.09) months. Epstein Barr virus (EBV) DNA and T stage were included in the RPA-generated risk stratification, categorizing patients into a good-prognosis group (EBV DNA ≤ 4000 copies/mL & T1–2), and a poor-prognosis group (EBV DNA ≤ 4000 copies/mL & T3–4 and EBV DNA > 4000 copies/mL & any T). Overall survival (OS) was significantly higher in the good-prognosis group compared with the training set (HR = 0.309, 95% CI 0.184–0.517; P < 0.001), and validated in the testing set (HR = 0.276, 95% CI 0.113–0.670; P = 0.002). In the poor-prognosis group, a significantly improved OS for chemoradiotherapy (CRT) compared with RT alone was observed (HR = 0.70, 95% CI 0.55–0.88; P = 0.003). Patients who received induction chemotherapy (IC) + concurrent chemoradiotherapy (CCRT) and CCRT had a significantly improved OS compared with RT alone (IC + CCRT vs. RT alone: P = 0.002; CCRT vs. RT alone: P = 0.008) but not in the IC + RT group ( P = 0.306). The 5-year OS for CRT versus RT-alone with ACE-27 scores of 0, 1 and 2 were 76.0% versus 70.0% ( P = 0.014), 80.5% versus 68.2% ( P = 0.150) and 58.5% versus 62.2% ( P = 0.490), respectively; for those aged 60–64, 65–70 and ≥ 70 years old they were 80.9% versus 75.9% ( P = 0.068), 73.3% versus 63.4% ( P = 0.270) and 64.8% versus 67.1% ( P = 0.820), respectively. Conclusions For elderly NPC patients a simple screening cutoff for chemotherapy beneficiaries might be EBV DNA < 4000 copies/ml & T3–4 and EBV DNA ≥ 4000 copies/ml & any T, but not for those > 70 years old and with an ACE-27 score > 1. IC + CCRT and CCRT were effective forms of chemotherapy.
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