Integrated strategies for chemotherapy cycles in nasopharyngeal carcinoma patients: Real-world data from two epidemic centers guiding decision-making  

作　　者：Zejiang Zhan Yingying Huang Jiayu Zhou Zhuochen Cai Haoyang Huang Ying Deng Wenze Qiu Xun Cao Xi Chen Chixiong Liang Lulu Zhang Xiang Guo Taize Yuan Xing Lyu 

机构地区：[1]Department of Nasopharyngeal Carcinoma,Sun Yat-sen University Cancer Center,the State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Guangzhou 510060,China [2]Department of Radiation Oncology,Affiliated Cancer Hospital and Institute of Guangzhou Medical University,Guangzhou 510095,China [3]Department of Critical Care Medicine,Sun Yat-sen University Cancer Center,the State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China [4]Department of Radiation Oncology,Guangzhou Concord Cancer Center,Guangzhou 510045,China

出　　处：《Chinese Journal of Cancer Research》2023年第2期126-139,共14页中国癌症研究（英文版）

基　　金：supported by grants from the National Natural Science Foundation of China(No.81872375 and 82172863);the Natural Science Foundation of Guangdong Province(No.2021A1515010118).

摘　　要：objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but not evidence-confirmed.This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy,toxicity and cost-effectiveness.Methods:This real-world study from two epidemic centers used propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)analyses.The enrolled patients were divided into three groups based on treatment modality:Group A(2IC+2CCRT),Group B(3IC+2CCRT or 2IC+3CCRT)and Group C(3IC+3CCRT).Long-term survival,acute toxicities and cost-effectiveness were compared among the groups.We developed a prognostic model dividing the population into high-and low-risk cohorts,and survivals including overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS)and locoregional relapse-free survival(LRRFS)were compared among the three groups according to certain risk stratifications.Results:Of 4,042 patients,1,175 were enrolled,with 660,419,and 96 included in Groups A,B and C,respectively.Five-year survivals were similar among the three groups after PSM and confirmed by IPTW.Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A(52.1%vs.41.5%vs.25.2%;41.7%vs.32.7%vs.25.0%)as were grade 3-4 nausea/vomiting and oral mucositis(29.2%vs.15.0%vs.6.1%;32.3%vs.25.3%vs.18.0%).Cost-effective analysis suggested that 2IC+2CCRT was the least expensive,while the health benefits were similar to those of the other groups.Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients,while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals,mainly reflected by LRRFS.Conclusions:In LA-NPC patients,2IC+2CCRT was the optimal choice regarding efficacy,toxicity and costeffectiveness;however,2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high-and low-

关 键 词：Nasopharyngeal carcinoma treatment modality chemotherapy cycle survival toxicity COSTEFFECTIVENESS real world 

分 类 号：R739.63[医药卫生—肿瘤]