Study On Comprehensive Treatment Strategy Of Locally Advanced Nasopharyngeal Carcinoma

Purpose:The present study aimed to construct and verify a mortality risk prognostic index(PI)to stratify nasopharyngeal carcinoma(NPC)into different risks,which could help clinicians evaluate prognosis and make treatment strategies.Methods:A prognostic model was established based on a retrospective study of 362 patients(the training set)from January 2008 to June 2011.Univariate and multivariate analyses were performed to find the independent prognostic factors for OS,and then these covariates were combined to construct prognostic model.The discriminative and calibration abilities of the model were evaluated by Harrell's concordance index(C-index),and calibration curves.Bootstrapping was used to perform for internal validation.External validation was conducted using 324 patients diagnosed with NPC from July 2011 to December 2012 at the same institution.Results:The primary PI comprised covariates that were associated with overall survival in the training cohort,including T stage,N stage,age,and plasma alkaline phosphatase.Discrimination by using a fixed PI score cut-off of407.96 determined from the training data set by maximally selected rank statistics yielded high-and low-risk subgroups with distinct survival outcomes in the validation cohort.Internal and external validation showed that the discrimination of the PI for overall survival was significantly better than that of the 8^th edition staging system of American Joint Committee on Cancer staging.Conclusions:The proposed prognostic model achieved good prediction and calibration of overall survival for patients with NPC.Purpose: We had previously constructed a prognostic model for nasopharyngeal carcinoma(NPC).In the present study,we aimed to apply the model to investigate the role of the addition of adjuvant chemotherapyto concurrent chemoradiotherapregimens for the treatment of NPC.Methods: Patients with local-regional advanced NPC who received concurrent chemoradiotherapy followed by adjuvant chemotherapy or concurrent chemoradiotherapy alone were included in the present study.According to the prognostic model,patients were stratified into high-risk and low-risk groups.Then survival analyses with the Log rank test were performed between concurrent chemoradiotherapy plus adjuvant chemotherapy and concurrent chemoradiotherapy alone groups for the high-risk and low-risk groups,respectively.If key baseline characteristics were not balanced between the two groups,the propensity score-matching method was used to match patients between these two groups in R software.Results: A total of 504 participants enrolled the study,with 307 cases in the high-risk group and 197 cases in the low-risk group based on the prognostic model.For high-risk patients,the concurrent chemoradiotherapy plus adjuvant chemotherapy showed improvement of overall survival than concurrent chemoradiotherapy alone before and after propensity score-matching,but not in terms of distant metastasis-free survival,and local-regional recurrence-free survival.For low-risk patients,the concurrent chemoradiotherapy plus adjuvant chemotherapy increased the risk of death(HR 3.915,95%CI 0.882-17.376;P = 0.053),and distant metastasis(HR4.222,95%CI 0.959 to 18.585;P = 0.038)in low-risk patients.After propensity score-matching,the additional adjuvant chemotherapy to concurrent chemoradiotherapy increased the risk of distant metastasis(HR 6.028,95%CI 0.783-46.375;P = 0.049),but no significant difference in overall survival was found between the two groups(HR 5.546,95%CI 0.716-42.986;P = 0.065).Conclusions: The addition of adjuvant chemotherapy might be a double-edged sword,bringing survival benefit to high-risk patients but greater risk of distant metastasis to low-risk patients.Purpose: To compare the efficacy and toxicities of cetuximab(CTX)or Nimotuzumab(NTZ)versus cisplatin(CDDP)concurrent with radiotherapy in locally advanced nasopharyngeal carcinoma(NPC).Methods: The strategy involved searching the Pub Med,Embase,Cochrane Library,China National Knowledge Internet Web,Wanfang and Chinese Biomedical databases.Controlled clinical trials that compared concurrent CTX/NTZ with radiotherapy versus CDDP with radiotherapy in local-regionally advanced NPC were included.Results: In all,1,239 patients in six clinical trials were included in the analysis.The hazard ratios(HRs)between the CTX/NTZ and CDDP groups were 1.01 [95%CI(Confidence interval)0.63-1.64],1.06(95%CI 0.50-2.25),1.04(95%CI 0.61-1.76),and 1.05(95%CI 0.73-1.50)for overall survival,local-regional failure-free survival,distant metastasis failure-free survival,and disease-free survival,respectively.Significant differences were found in the incidences of grade 3-4 anaemia [Risk ratio(RR)0.11,95%CI 0.02-0.58],grade 3-4 neutropenia(RR 0.23,95%CI 0.12-0.44),grade 3-4 thrombocytopenia(RR 0.31,95%CI 0.12-0.79),and grade 3-4 vomiting(RR 0.04,95%CI 0.00-0.29)in favour of the CTX/NTZ group.However,the patients in the CTX/NTZ group experienced a higher incidence of grade 3-4 skin rash(RR 6.45,95%CI 3.84-10.84).Conclusions: Compared to concurrent chemotherapy,concurrent CTX / NTZ could supply the equal survival benefit,and fewer grade 3-4 haematological side effects in local-regionally advanced NPC.