Induction Chemotherapy Improved Long-term Outcomes of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Analysis of 5-year Survival Outcomes in the Era of Intensity-modulated Radiotherapy

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

Abstract

Background: The aim of this study is to evaluate the long-term therapeutic gain of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). Methods: Data on 957 patients with stage T1-2N2-3 or T3-4N1-3 NPC treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance influence of various covariates. Patient survival between IC and non-IC groups were compared. Results: For the 318 pairs selected from the original 957 patients by PSM, the median follow-up duration was 57.13 months (range, 1.27-78.1 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and locoregional relapse-free survival (LRRFS) rates for IC group vs. non-IC group were 87.2% vs. 80.8% (P = 0.023), 88.1% vs. 83.2% (P = 0.071), 80.7% vs. 71.4% (P = 0.011) and 92.1% vs. 86.7% (P = 0.081), respectively. Multivariate analysis identify IC as an independent prognostic factor for OS (HR, 0.595; 95% CI, 0.397-0.891; P = 0.012) and DFS (HR, 0.627; 95% CI, 0.451-0.872; P = 0.006). After excluding the patients not receiving concurrent chemotherapy, IC was found to be an independent prognostic factor for OS (HR, 0.566; 95% CI, 0.368-0.872; P = 0.01), DMFS (HR, 0.580; 95% CI, 0.367-0.916; P = 0.02) and DFS (HR, 0.633; 95% CI, 0.444-0.903; P = 0.012). Conclusions: IC is an effective treatment modality for patients with stage T1-2N2-3 and T3-4N1-3 NPC, and the incorporation of IC with standard CCRT could achieve the best therapeutic gain.

Keywords: Nasopharyngeal carcinoma; induction chemotherapy; intensity-modulated radiotherapy; locoregionally advanced; prognosis..

Conflict of interest statement

Competing Interests: The authors declare no competing financial interests.

Figures

Figure 1
Figure 1
Kaplan-Meier OS (A), DMFS (B), DFS (C) and LRRFS (D) curves for the 318 pairs of stage III-IVB NPC with or without IC. Abbreviations: OS = overall survival; DMFS = distant metastasis-free survival; DFS = disease-free survival; LRRFS = locoregional relapse-free survival; IC = induction chemotherapy.
Figure 2
Figure 2
Kaplan-Meier OS (A), DMFS (B), DFS (C) and LRRFS (D) curves for the 276 pairs of stage III-IVB NPC patients receiving CCRT with or without IC. Abbreviations: OS = overall survival; DMFS = distant metastasis-free survival; DFS = disease-free survival; LRRFS = locoregional relapse-free survival; IC = induction chemotherapy; CCRT = concurrent chemoradiotherapy.

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