| Background & objective: Radiotherapy is the most important and effective treatment for nasopharyngeal carcinoma(NPC).The main effect of chemotherapy is to improve the sensitivity of local radiotherapy and kill micrometastases.Radiotherapy combined with concurrent chemotherapy can significantly improve the prognosis of patients with advanced nasopharyngeal carcinoma compared with radiotherapy alone.The TNM staging system of tumor anatomy,lymph node and metastasis has always been considered to be the most important survival index in patients with nasopharyngeal carcinoma.There are often significant differences in survival outcomes among patients with different T-N subgroups which play a vital role in the development of treatment plans.The UICC/AJCC staging system for nasopharyngeal carcinoma has been updated to version 8,in which both T and N staging have been modified accordingly.The purpose of this study was to compare the effects of cisplatin cumulative dose(CCD)on the prognosis of patients with different stages underthe guidance of the eighth edition of the staging system,and to provide a reference for the formulation of a reasonable individualized comprehensive treatment plan.Methods: from January 2010 to December 2013,392 patients with nasopharyngeal carcinoma diagnosed pathologically in the first affiliated Hospital of Guangxi Medical University and without distant metastasis were enrolled in this study.The median cumulative dose of cisplatin 240mg/ ?(60-500mg/?)was used as the stratified dose level.According to the risk of treatment failure,the patients with T1-3,N0-1 were divided into low risk group,T4 and N2-3 patients were divided into high risk group.The main endpoints of observation were 5-year overall survival(OS),locoregional failure-free survival(LRFFS),distant metastasis-free survival(DMFS)and progression-free survival(PFS).The baseline characteristics of the two groups were compared by chi-square test,the survival curve was drawn by Kaplan-Meier method and compared by log-rank test.the variables of univariate analysis(P < 0.05)were included in Cox regression model for multivariate analysis.The P value of bilateral test P < 0.05 was statistically different.Results: In the whole group,univariate analysis showed that the cumulative dose of cisplatin group(?240mg/ ?)was significantly better than that of low dose group(< 240mg/?)in 5-year OS(82.8%vs.74.4%,P=0.036)and PFS(80.0%vs.70.7%,P=0.035),there was a tendency to improve DMFS(85.4%vs.78.2%,P=0.073),but there was no significant difference in LRFFS(92.6%vs.89.8%,P=0.403).In multivariate analysis,the cumulative dose of cisplatin was an independent prognostic factor for OS(HR :1.976,95% CI 1.293-3.021,P = 0.002,)and PFS(HR:0.532,95%CI 0.351-0.805,P=0.003).Subgroup analysis showed that in low-risk group,5-year OS(90.7%vs.93.7%,P=0.835)? LRFFS(94.4%vs.97.9%,P=0.372)?DMFS(92.6%vs.91.7%,P=0.867)and PFS(90.7%vs.89.6%,P=0.856).In high-risk group,5-year OS(80.8%vs.67.1%,P=0.002)?LRFFS(92.0%vs.86.5%,P=0.127)?DMFS(82.9%vs.73.0%,P=0.025)and PFS(77.6%vs.64.3%,P=0.003).Further multivariate analysis of the subgroups of the high-risk group showed that the cumulative dose of cisplatin was an independent prognostic factor for OS(HR:1.827,95%CI:1.168-2.857,P=0.008),DMFS(HR:1.075,95%CI:1.032-2.818,P=0.037)and PFS(HR : 1.657,95%CI : 1.070-2.564,P=0.023).Conclusion: The cumulative dose of cisplatin is an independent prognostic factor affecting OS and PFS in patients with nasopharyngeal carcinoma,and patients with stage T4 and N2-3 can benefit from high dose chemotherapy. |
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