Validation of published nomograms and accordingly individualized induction chemotherapy in nasopharyngeal carcinoma

Ou-Yang, Pu; Zhang, Lu Ning; Xiao, Yao; Lan, Xiao Wen; Zhang, Xiao Min; Ma, Jingfei; Xie, Fang

doi:10.1016/j.oraloncology.2017.01.009

Cited by 14 publications

(17 citation statements)

References 24 publications

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“…In previous studies, several prognostic models were put forward to help select high-risk patients that might benefit from IC (20)(21)(22). Zhang et al developed and validated a nomogram to predict individual benefit of IC based on a Phase III clinical trial (22).…”

Section: Discussionmentioning

confidence: 99%

Stratification of Candidates for Induction Chemotherapy in Stage III-IV Nasopharyngeal Carcinoma: A Large Cohort Study Based on a Comprehensive Prognostic Model

Sun

Xiao

et al. 2020

Front. Oncol.

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Objective: To establish a prognostic index (PI) for patients with stage III-IV nasopharyngeal carcinoma (NPC) patients to personalize recommendations for induction chemotherapy (IC) before intensity-modulated radiotherapy (IMRT). Patients and Methods:Patients received concurrent chemoradiotherapy (CCRT) with or without IC. Factors used to construct the PI were selected by a multivariate analysis of progression-free survival (PFS), which was the primary endpoint (P < 0.05). Five variables were selected based on a backward procedure in a Cox proportional hazards model: gender, T stage, N stage, lactate dehydrogenase (LDH), and Epstein-Barr virus (EBV) DNA. The cutoff value for the PI was determined by the receiver operating characteristic curve analysis.Results: The present study involved 3,586 patients diagnosed with stage III-IV NPC. The cutoff value for PI was 0.8. The high-risk subgroup showed worse outcomes than did the low-risk subgroup on all endpoints: PFS, overall survival (OS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS). In the low-risk subgroup (PI < 0.8), patients showed comparable survival outcomes on all clinical endpoints regardless of IC application, whereas in the high-risk subgroup (PI > 0.8), the addition of IC significantly improved PFS, OS, and DMFS, but not LRFS. In multivariate analyses, IC was a protective factor for PFS, OS, and DMFS in the high-risk subgroup, while it had no significant benefit in the low-risk subgroup.Conclusion: The proposed prognostic model effectively stratifies patients with stage III-IV NPC. High-risk patients are candidates for IC before CCRT, while low-risk patients are unlikely to benefit from it.

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Section: Discussionmentioning

confidence: 99%

Stratification of Candidates for Induction Chemotherapy in Stage III-IV Nasopharyngeal Carcinoma: A Large Cohort Study Based on a Comprehensive Prognostic Model

Sun

Xiao

et al. 2020

Front. Oncol.

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“…In the real‐world clinical practice, however, the efficacy of induction chemotherapy was minimal, as observed in different populations . Perhaps a more precise selection of real high‐risk patients based on prognostic tools (e.g., tumor volume , Epstein‐Barr virus deoxyribonucleic acid , or nomogram ) and application of new chemotherapy regimens might be the promising strategies for induction chemotherapy in the future.…”

Section: Discussionmentioning

confidence: 99%

A Pairwise Meta-Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma

et al. 2019

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Background. Locoregionally advanced nasopharyngeal carcinoma has high risk of distant metastasis and mortality. Induction chemotherapy is commonly administrated in clinical practice, but the efficacy was quite controversial in and out of randomized controlled trials. We thus conducted this pairwise meta-analysis. Materials and Methods. Trials that randomized patients to receive radiotherapy or concurrent chemoradiotherapy with or without induction chemotherapy were identified via searches of PubMed, MEDLINE, and ClinicalTrials.gov. Results. A total of ten trials (2,627 patients) were included. The pooled hazard ratios (HRs) based on fixed effect model were 0.68 (95% confidence interval [CI] 0.56-0.80, p < .001) for overall survival (OS) and 0.70 (95% CI 0.61-0.79, p < .001) for progression-free survival (PFS), which strongly favored the addition of induction chemotherapy. The absolute 5-year survival benefits were 8.47% in OS and 10.27% in PFS, respectively. In addition, based on the available data of eight trials, induction chemotherapy showed significant efficacy in reducing locoregional failure rate (risk ratio [RR] = 0.81, 95% CI 0.68-0.96, p = .017) and distant metastasis rate (RR = 0.69, 95% CI 0.58-0.82, p < .001).Conclusion. This pairwise meta-analysis confirms the benefit in OS, PFS, and locoregional and distant controls associated with the addition of induction chemotherapy in nasopharyngeal carcinoma. The Oncologist 2019;24:505-512 Implications for Practice: According to the results of this meta-analysis of ten trials, induction chemotherapy can prolong overall survival and progression-free survival and improve locoregional and distant controls for nasopharyngeal carcinoma.

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“…An explanation to that is that in this study, 112 (94.1%) patients with stage III and IV received ICT, and in the IMRT era, ICT applied in loco-regionally advanced nasopharyngeal carcinoma can significantly reduce the risk of distant metastasis. 20,[27][28][29] In addition, N stage was an independent predictor for DMFS in the multivariate Cox proportional hazards model analysis due to lymphatic drainage into the blood. That finding was consistent with the latest research.…”

Section: Discussionmentioning

confidence: 95%

<p>Long-Term Survival After Nasopharyngeal Carcinoma Treatment in a Local Prefecture-Level Hospital in Southern China</p>

Zhang

Feng

et al. 2020

CMAR

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Purpose: NPC is a malignant and invasive tumor with the incidence rate of 19/100,000per year in Zhongshan City, a prefecture city in southern China. Long-term survival analysis on intensity-modulated radiotherapy (IMRT)-based treatment in local prefecture-level hospitals have not been investigated. We aimed to evaluate the 5-year clinical outcomes and prognostic factors of NPC treated with IMRT in Zhongshan City People's Hospital (ZSPH), a prefecture-level hospital in South China. Patients and Methods: The number of 149 newly diagnosed non-metastatic NPC cases treated with IMRT were included from Zhongshan City People's Hospital between January 2010 and December 2011. The survival outcomes, treatment toxicities and prognostic factors were analyzed by Kaplan-Meier method and Cox proportional hazards model. Results: With a median follow-up period of 65 months for the cohort, the 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) and overall survival (OS) were 86.80%, 94.80%, 86.10% and 80.50%, respectively. The 5-year OS rates were 100%, 95.2%, 87% and 67.2% for stage I, II, II and IVa-b, respectively (P=0.004). The 5-year LRFS rates were 97.2%, 96.0%, 90.4% and 72.0% for T1, T2, T3 and T4, respectively (P=0.001); the 5-year DMFS rates were 100% for T1, 96.8% for T2, 81.9% for T3 and 74.6% for T4 (P=0.022). A multivariate analysis revealed tumor stage as an independent prognostic factor for LRFS, DMFS and OS. No patients died from acute toxicities. Late toxicities were observed for 130 (87.2%) patients, and most late toxicities were graded I/II. Conclusion: NPC treatment effect in a prefecture-level hospital in South China was comparable to international results and toxicities were tolerable. Tumour stage was an independent prognostic factor for survival outcome. More NPC survival data from local and remote places are needed.

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Validation of published nomograms and accordingly individualized induction chemotherapy in nasopharyngeal carcinoma

Abstract: Tang's nomogram helps to stratify stage III-IVa-b NPC, and IC is beneficial to high-risk patients in clinical practice.

Cited by 14 publications

References 24 publications

Stratification of Candidates for Induction Chemotherapy in Stage III-IV Nasopharyngeal Carcinoma: A Large Cohort Study Based on a Comprehensive Prognostic Model

Stratification of Candidates for Induction Chemotherapy in Stage III-IV Nasopharyngeal Carcinoma: A Large Cohort Study Based on a Comprehensive Prognostic Model

A Pairwise Meta-Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma

<p>Long-Term Survival After Nasopharyngeal Carcinoma Treatment in a Local Prefecture-Level Hospital in Southern China</p>

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