Can neoadjuvant chemotherapy improve survival in stage T3-4N1 nasopharyngeal carcinoma? A propensity matched analysis

Abstract

Background: To estimate the efficacy of neoadjuvant chemotherapy (NCT) in stage T3-4N1 nasopharyngeal carcinoma (NPC). Methods: Data on stage T3-4N1 NPC patients treated with concurrent chemoradiotherapy (CCRT) with or without NCT at the Sun Yat-sen University Cancer Center between January 2006 and December 2013 were retrospectively reviewed. Propensity score matching (PSM) was carried out to balance prognostic factors in NCT followed by CCRT (NCT + CCRT) group and CCRT group in a 1:1 ratio. Survival outcomes of matched patients in the two groups were compared, and prognostic factors were identified using Cox regression model. Results: A total of 282 patients were involved in this study, with 136 of NCT + CCRT group and 146 of CCRT group. After PSM, 85 pairs of patients were selected. There were no significant differences in 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and recurrence-free survival (RFS) between NCT + CCRT group and CCRT group (81.0% vs. 77.5%, P = 0.750; 85.8% vs. 88.1%, P = 0.495; 92.5% vs. 93.9%, P = 0.759; 81.0% vs.77.5%, P = 0.919, respectively). Multivariate analysis found that smoking history (P = 0.044) and T classification (P = 0.027) were independent prognostic factors for OS, lymph node diameter (P = 0.032) was independent prognostic factor for LRFS, positive pretreatment lymph node condition (PLNC), which was defined as the lymph node necrosis or confluent, was independent prognostic factor for DRFS (P = 0.007), and RFS (P = 0.009). Lower 5-year OS (82.7% vs. 94.1%, P = 0.014), DRFS (79.3% vs. 96.2%, P = 0.003), and RFS (62.4% vs. 86.8%, P = 0.001) were found in positive PLNC group compared with negative PLNC group. In terms of toxicities, the incidences of acute hematological Grade 3-4 adverse events (AEs) were higher in NCT + CCRT group compared with CCRT group (P < 0.05), while no significant difference was observed in the rates of non-hematological Grade 3-4 AEs between these two groups (P > 0.05).

A Nomogram to Identify the Optimal Candidates for Induction Chemotherapy in Advanced N-Stage Nasopharyngeal Carcinoma

“…Also, previous studies have reported that IC might not improve survival for patients with T3-4N0-1 NPC but was associated with higher incidences of acute toxicities. [25][26][27][28] These findings suggest that IC might improve survival only in patients with a larger tumor burden. Compare to N0-1 patients, patients with large and/or extensive lymphnode disease (N2-3) are high-risk subgroups.…”

A Nomogram to Predict Survival and Determine Necessity of Induction Chemotherapy for Patients With Stage T3-4N1 Nasopharyngeal Carcinoma

“…Notably, unlike the other studies, these two studies covered all LA-NPC patients. The inclusion of stage T3-4N0-1 patients may decrease the power of the trials to detect a survival bene t, as these subgroups were considered to have low risk of treatment failure and not warranting additional IC (22)(23)(24). Although the latest NCCN guidelines recommended IC plus CCRT as one of the most appropriate treatments for LA-NPC, clinicians should notice inconsistent bene t of IC in various subgroups.…”

The optimum number of induction chemotherapy cycles for N3M0 stage nasopharyngeal carcinoma based on pre-treatment plasma EBV DNA

“…Furthermore, prior research indicated that the utilization of IC might yield greater e cacy in enhancing OS and DMFS among patients with advanced N stage [11]. However, IC did not correlate with enhanced survival results for patients with T3-4N0-1, and it led to higher incidences of grade 3-4 hematological toxicities [12]. Gemcitabine plus cisplatin, docetaxel, cisplatin, and uorouracil, cisplatin plus uorouracil, and docetaxel plus cisplatin are the IC regimens recommended in the NCCN guideline and commonly utilized in clinical practice.…”