The Short-term Efficacy Analysis Of Neoadjuvant Chemotherapy And Establishment Of A Prediction Model For Nasopharyngeal Carcinoma

Background:Nasopharyngeal carcinoma is one of the most common malignant tumors of head and neck,especially in the Southern China region. It is difficult for surgery to excise the malignant tumor completely because of its deep location and being surrounded by a lot of important organizations and tissues. Therefore, radiotherapy combined with chemotherapy is the primary treatment for nasopharyngeal carcinoma. chemotherapy is systemic treatment which has advantage in killing distant metastatic cancer cells. The concurrent chemoradiation therapy has been defined as the standard treatment for nasopharyngeal carcinoma, however the serious side effects caused poor tolerance and low completion rate of chemotherapy. Because of good tolerance in patient and abundant blood supply in the tumor, neoadjuvant chemotherapy has the potential to reduce distant metastasis,reduce the tumor volume quickly and provide better treatment target for subsequent radiation therapy. Therefore, to predict the efficacy of neoadjuvant chemotherapy and to improve the follow-up treatment procedures combined with radiotherapy have become a hot topic.Objectives:To analyze a variety of clinical factors that may affect the efficacy of neoadjuvant chemotherapy in nasopharyngeal carcinoma, and establish a model to predict the clinical response of neoadjuvant chemotherapy for nasopharyngeal carcinoma, and to provide evidence for the individual treatment.Methods:According to the NCCN guidelines, 65 cases of patients with nasopharyngeal carcinoma confirmed by histopathological diagnosis received two cycles of neoadjuvant chemotherapy with TP regimen. The clinical efficacy was evaluated two weeks after the last neoadjuvant chemotherapy was completed. Clinical data of 65 patients were retrospectively analyzed, and Logistic regression analysis was used to construct the neoadjuvant chemotherapy curative effect prediction model.Results:1. The response rate was 38.5% and 52.5% in the nasopharyngeal lesions and metastatic lesions in cervical lymph node, respectively.2.The univariate analysis showed that the patients with no distant metastasis, no cranial nerve invasion, EBV negative and high expression of Ki-67 were more sensitive to neoadjuvant chemotherapy.3.Multivariate analysis showed that distant metastasis, cranial nerve invasion and the status of plasma EBV negative affected the efficacy of neoadjuvant chemotherapy.4.The prediction model is established: Logit=-0.854-2.024×distant metastasis +1.699×cranial nerve invasion+3.752×EBV. The sensitivity was 69.0%,specificity was 80.6%, positive predictive value was 76.3% and negative predictive value was 74.1%, respectively.Conclusion:1.The distant metastasis, cranial nerve invasion and EBV infection may be important predictive factors of neoadjuvant chemotherapy for the advanced nasopharyngeal carcinoma, which may provide a preliminary basis for individualized treatment of patients with nasopharyngeal carcinoma.2.The high expression of Ki-67, EBV negative, no cranial nerve invasion may be important predictive factors for nasopharyngeal lesions.3.The high expression of Ki-67, EBV negative, no cranial nerve invasion and no distant metastasis may be important predictive factors for the local control rate of metastatic lesions in cervical lymph node.4.The local control rate of nasopharyngeal lesions is correlated with T stage in nasopharyngeal carcinoma.5.The local control rate of metastatic lesions in cervical lymph node is not associated with the N stage in nasopharyngeal carcinoma.