Background: We investigated the dynamic variation and prognostic value of weight loss among nasopharyngeal carcinoma (NPC) patients. Methods: 1149 newly diagnosed NPC patients receiving radical radiotherapy (RT) were retrospectively analyzed. Patients’ weights were measured at initiation of RT and every week during RT. Recursive partitioning analyses (RPAs) were utilized to determine cut-off value for rate of weight loss (RWL). To assess predictive value of RWL survival analysis was performed. Disease-free survival (DFS) was our primary endpoint. Secondary endpoints included locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS).Results: RWLs were 0%, 0%, -1.54%, -2.86%, -4.11%, -5.98%, -6.56% at 1st, 2nd, 3rd, 4th, 5th, 6th, and 7th week of RT, respectively. RWL optimal threshold with respect to DFS was 5.3% based on RPAs. Thus, a consistent threshold of -5% (>-5% versus ≤-5%) was selected to classify NPC patients into low RWL and high RWL groups for survival analysis. Compared to high RWL (≤-5%), patients with low RWL (>-5%) had significantly better ten-year DFS (78.6% versus 61.2%; P< 0.001), OS (86.6% versus 70.1%; P< 0.001), and DMFS (88.5% versus 80.2%; P = 0.007). However, no difference was observed between LRRFS groups (91.7% versus 94.3%; P= 0.173). In multivariate analysis, RWL ≤-5% was an independent risk factor for DFS (HR, 1.56; 95% CI, 1.19-2.03; P= 0.001), OS (HR, 1.54; 95% CI, 1.11-2.15; P= 0.011) and DMFS (HR, 1.47; 95% CI, 1.03-2.10; P= 0.033) in patients with NPC. Additionally, chemotherapy and old age were attributed to the development of high RWL.Conclusions: Weight loss during RT was significantly associated with decreased survival among NPC patients. Clinicians should continuously inform patients on the health impact of minimizing weight loss under 5%.
Background: The purpose of this study was to evaluate the benefit to be gained from the addition of local radiotherapy to systemic chemotherapy in patients with newly diagnosed metastatic nasopharyngeal carcinoma in endemic areas of Southern China.Methods: The data of patients with metastatic nasopharyngeal carcinoma (n = 649) were retrospectively analyzed: 313 patients received only chemotherapy and 336 received chemotherapy plus radiotherapy. The characteristics of the radiotherapy and chemoradiotherapy groups were compared using the chi-square test or Fisher exact test. Survival was analyzed using the Kaplan–Meier method. A Cox proportional hazard model was used to identify the factors independently associated with survival.Results: Median follow-up was for 36 months. In univariate analysis, radiotherapy was significantly associated with improved survival (median OS 27 vs. 18 months; 5-year OS 36.4% vs. 20.1%; P < 0.001). In multivariate analysis, radiotherapy was an independent predictor of survival (HR, 0.65; CI, 0.53-0.79; P < 0.001). Other independent prognostic factors included number of metastatic organs, smoking, body mass index, hemoglobin, and N stage. In subgroup analysis, chemoradiotherapy was associated with improved survival in both the single-organ metastasis group (5-year OS, 38.5% vs. 25.1%; P < 0.001) and the multiorgan metastases group (5-year OS, 25.0% vs. 9.7%; P = 0.003).Conclusion: The addition of local radiotherapy to chemotherapy appears to improve survival in patients with metastatic nasopharyngeal carcinoma. Even patients with multiorgan metastases may benefit from radiotherapy.
Purpose Although the use of regorafenib plus nivolumab demonstrates promising outcomes in patients with refractory microsatellite stable (MSS) metastatic colorectal cancer (mCRC), other studies failed to observe such an effect. In addition, a comparison between regorafenib combined with programmed cell death protein 1 (PD-1) antibodies and regorafenib monotherapy has rarely been reported. The aim of this study was to assess whether regorafenib combined with a PD-1 antibody is superior to regorafenib monotherapy as third-line treatment for MSS mCRC. Methods Patients with MSS mCRC who received regorafenib combined with a PD-1 antibody or regorafenib monotherapy as third-line treatment were eligible for inclusion. Results In total, 179 patients were enrolled, of which 95 administered regorafenib combined with a PD-1 antibody and 84 administered regorafenib monotherapy. Overall, patients who administered regorafenib combined with a PD-1 antibody had similar progression-free survival (PFS) outcomes as those on regorafenib monotherapy (median PFS was 2.4 months and 1.9 months, respectively, P = 0.086). The administration of regorafenib combined with a PD-1 antibody showed significantly longer PFS than regorafenib monotherapy in both male (5.2 months vs. 2.4 months, P = 0.001) and female (3.9 months vs. 1.8 months, P = 0.037) patients without liver metastasis. Unexpectedly, female patients with liver metastasis who administered regorafenib combined with a PD-1 antibody showed inferior PFS outcomes than those who administered regorafenib monotherapy (1.8 months vs. 2.0 months, P = 0.030). Conclusion Liver metastasis and gender were predictors of survival benefit following the addition of a PD-1 antibody to regorafenib in patients with MSS mCRC.
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