| Background:At present,which of the three therapeutic regimes among induction chemotherapy+concurrent chemoradiotherapy(IC+CCRT),concurrent chemoradiotherapy+adjuvant chemotherapy(CCRT+AC)and induction chemotherapy+concurrent chemoradiotherapy+adjuvant chemotherapy(IC+CCRT+AC)brings the most benefits for patients with locally advanced nasopharyngeal carcinoma(NPC)remains controversial.Therefore,it is necessary to further explore the optimal chemotherapy regime for locally advanced NPC.Methods:Clinical data of 1812 NPC patients who were initially admitted to Nanfang Hospital of Southern Medical University from January to December 2015 we collected.Clinical data of 729 patients who met the inclusion criteria were retrospectively analyzed.Among 729 patients,220 cases received IC+CCRT,170 received CCRT+AC and 339 received IC+CCRT+AC.All patients were followed up.The toxic and adverse events and clinical prognosis were statistically analyzed among three chemotherapy regimens.According to the baseline clinical variables of patients,an innovative risk scoring system was constructed using statistical methods to predict the risk of treatment failure for locally advanced NPC patients.Then,the scoring system was utilized to perform stratified survival analysis,and to determine the optimal chemotherapy regime for the stratified patients.Results:The median follow-up time of 729 patients was 47 months.Univariate analysis demonstrated that the 3-year failure-free survival(FFS)was 75.6%,74.8%and 69.9%in the IC+CCRT,CCRT+AC and IC+CCRT+AC groups,respectively(P=0.225),90.1%,90.4%and 88.9%for the 3-year overall survival(OS)(P=0.992),91.7%,92.5%and 89.9%for the 3-year locoregional failure-free survival(LFFS)(P=0.549),and 84.9%,80.6%and 78.7%for the 3-year distant failure-free survival(DFFS)(P=0.174).FFS,OS,LFFS and DFFS did not significantly differ among three groups.In terms of toxic and adverse events,the incidence rate of grade 3-4 leukopenia in the IC+CCRT group was significantly lower than that in the CCRT+AC group(16.4%vs.31.8%,P<0.01)and the IC+CCRT+AC group(16.4%vs.28.8%,P<0.01).To further analyze the advantages and disadvantages between the IC+CCRT and CCRT+AC chemotherapy regimens,we constructed a treatment failure risk scoring system based on the baseline clinical variables of each patient.Further stratified survival analysis based on the scoring system showed that FFS,OS,LFFS and DFFS in IC+CCRT group and CCRT+AC group had no statistical difference between the two groups in the low-risk group.In the high-risk group,IC+CCRT increased OS for 3 years(88.3%vs.77.6%,p=0.049)and DFFS for 3 years(84.0%vs.66.8%,p=0.032),compared with the CCRT+AC group.By comparing the differences between the number of different chemotherapies,we found that receiving 2 inductions of chemotherapy did not increase any survival benefit and increased gastrointestinal toxicity in patients compared to receiving 1 induction(G2-G3 gastrointestinal reactivity rates were 26.6%and 53.4%,p=0.001,for receiving 1 IC versus 2 ICs,respectively).The different number of adjuvant chemotherapy treatments had no significant effect on the patient’s survival outcome and the occurrence of toxic side effects.Conclusion:If only TNM staging factors were considered,IC+CCRT,CCRT+AC and IC+CCRT+AC had similar therapeutic effects.When stratifying patients with the risk assessment model constructed by us,the CCRT+AC option is recommended for patients at low risk of treatment failure,and the IC+CCRT option is recommended for those at high risk of treatment failure.Patients with locally advanced NPC who choose IC+CCRT are recommended to receive 1 induction course of chemotherapy with rapid synchronous radiotherapy;patients with locally advanced NPC who choose CCRT+AC are recommended to receive 1 adjuvant course of chemotherapy with close follow-up. |
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