The Tumour Response to Induction Chemotherapy has Prognostic Value for Long-Term Survival Outcomes after Intensity-Modulated Radiation Therapy in Nasopharyngeal Carcinoma

Hao Peng, Lei Chen, Yuan Zhang, Wen-Fei Li, Yan-Ping Mao, Xu Liu, Fan Zhang, Rui Guo, Li-Zhi Liu, Li Tian, Ai-Hua Lin, Ying Sun, Jun Ma, Hao Peng, Lei Chen, Yuan Zhang, Wen-Fei Li, Yan-Ping Mao, Xu Liu, Fan Zhang, Rui Guo, Li-Zhi Liu, Li Tian, Ai-Hua Lin, Ying Sun, Jun Ma

Abstract

The prognostic value of the tumour response to induction chemotherapy (IC) for long-term survival outcomes after intensity-modulated radiation therapy in nasopharyngeal carcinoma (NPC) remains unknown. We retrospectively reviewed 1811 consecutive patients with newly diagnosed NPC treated using IMRT, and 399 eligible patients with pre- and post-induction chemotherapy magnetic resonance images were recruited. The clinicopathological features of patients with different tumour responses were compared using the Chi-square test or Fisher's exact test. Prognostic value was assessed using a multivariate Cox proportional hazards model. After IC, 101/399 (25.3%) patients had a complete tumour response overall (CR), 262 (65.7%) had a partial response (PR) and 36 (9.0%) had stable disease (SD). The 4-year disease-free survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRRFS) rates for CR vs. PR vs. SD were 90.0% vs. 79.0% vs. 58.2% (CR vs. PR: P1 = 0.007; CR vs. SD: P2 < 0.001; PR vs. SD: P3 = 0.004), 95.7% vs. 88.7% vs. 70.2% (P1 = 0.017, P2 < 0.001, P3 = 0.005), 92.0% vs. 87.4% vs. 74.3% (P1 = 0.162, P2 = 0.005, P3 = 0.029) and 95.9% vs. 88.8% vs. 81.8% (P1 = 0.024, P2 = 0.006, P3 = 0.268), respectively. Multivariate analysis identified that the tumour response to IC was an independent prognostic factor for DFS, OS and LRRFS.

Figures

Figure 1
Figure 1
Kaplan-Meier DFS (1A), OS (1B), DMFS (1C) and LRRFS (1D) curves for 399 patients with NPC receiving IMRT stratified as the CR, PR and SD groups based on overall tumour response after induction chemotherapy. Abbreviations: DFS = disease-free survival; OS = overall survival; LRRFS = local-regional relapse-free survival; DMFS = distant metastasis-free survival. CR = complete response; PR = partial response; SD = stable disease.
Figure 2
Figure 2
Kaplan-Meier DFS (2A), OS (2B), LRFS (2C) and DMFS (2D) curves for 399 patients with NPC receiving IMRT stratified as the CR, PR and SD groups based on the local tumour response after induction chemotherapy. Abbreviations: DFS = disease-free survival; OS = overall survival; LRFS = local relapse-free survival; DMFS = distant metastasis-free survival. CR = complete response; PR = partial response; SD = stable disease.
Figure 3
Figure 3
Kaplan-Meier DFS (3A), OS (3B), RRFS (3C) and DMFS (3D) curves for 399 patients with NPC receiving IMRT stratified as the CR, PR and SD groups based on the regional tumour response after induction chemotherapy. Abbreviations: DFS = disease-free survival; OS = overall survival; RRFS = regional relapse-free survival; DMFS = distant metastasis-free survival. CR = complete response; PR = partial response; SD = stable disease.

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