期刊
FRONTIERS IN ONCOLOGY
卷 9, 期 -, 页码 -出版社
FRONTIERS MEDIA SA
DOI: 10.3389/fonc.2019.01343
关键词
nasopharyngeal carcinoma; Epstein-Barr virus; induction chemotherapy; concurrent chemoradiotherapy; recursive partitioning analysis
类别
资金
- National Natural Science Foundation of China [81930072]
- Key-Area Research and Development Program of Guangdong Province [2019B020230002]
- Natural Science Foundation of Guangdong Province [2017A030312003]
- Health & Medical Collaborative Innovation Project of Guangzhou City, China [201803040003]
- Innovation Team Development Plan of the Ministry of Education [IRT_17R110]
- Overseas Expertise Introduction Project for Discipline Innovation (111 Project) [B14035]
Background and Purpose: Evidence for induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) in nasopharyngeal carcinoma (NPC) was derived from landmark clinical trials excluding the T3N0, T3N1, T4N0 subgroups. This study used Epstein-Barr virus (EBV) DNA to select IC beneficiaries from the three subgroups. Materials and Methods: Significant predictors of overall survival (OS) were identified using multivariate Cox analyses. Risk stratification was generated using recursive partitioning analysis (RPA). IC+CCRT was compared with CCRT in each risk stratification and in different subgroups. Individual-level data from a clinical trial (NCT01245959) was used for validation. Results: Gender and EBV DNA were included in RPA-generated risk stratification, categorizing patients into low-risk (EBV DNA <2,000 copies/mL; female and EBV DNA >= 2,000 copies/mL) and high-risk groups (male and EBV DNA >= 2,000 copies/mL). The OS superiority of IC+CCRT over CCRT was only observed in the high-risk group (HR = 0.64, 95% CI = 0.43-0.97; P = 0.032). Subgroup analysis indicated the OS benefit was exclusively from the docetaxel-cisplatin-5-fluorouracil regimen (HR = 0.41, 95% CI = 0.22-0.78; P = 0.005). The status of the T3N1 subgroup as an IC beneficiary is more explicit than the T3N0 and T4N0 subgroups. IC+CCRT showed improved OS in the validation cohort combining high-risk cases of real-world data with clinical trial data (HR = 0.62, 95% CI = 0.42-0.94; P = 0.023). Conclusion: Patients with high-risk T3N1 NPC is the definite target population for receiving IC+CCRT in real-world practice. T3N0 and T4N0 subgroups need further investigations in future IC-related studies.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据