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. 2020 Jul 2;15(1):160.
doi: 10.1186/s13014-020-01594-4.

Can neoadjuvant chemotherapy improve survival in stage T3-4N1 nasopharyngeal carcinoma? A propensity matched analysis

Lei Wang  1 , Zheng Wu  2 , Dehuan Xie  3 , Shaowen Lv  4 , Liangping Xia  5 , Yong Su  6
Affiliations

Can neoadjuvant chemotherapy improve survival in stage T3-4N1 nasopharyngeal carcinoma? A propensity matched analysis

Lei Wang et al. Radiat Oncol. .

Abstract

Background: To estimate the efficacy of neoadjuvant chemotherapy (NCT) in stage T3-4N1 nasopharyngeal carcinoma (NPC).

Methods: Data on stage T3-4N1 NPC patients treated with concurrent chemoradiotherapy (CCRT) with or without NCT at the Sun Yat-sen University Cancer Center between January 2006 and December 2013 were retrospectively reviewed. Propensity score matching (PSM) was carried out to balance prognostic factors in NCT followed by CCRT (NCT + CCRT) group and CCRT group in a 1:1 ratio. Survival outcomes of matched patients in the two groups were compared, and prognostic factors were identified using Cox regression model.

Results: A total of 282 patients were involved in this study, with 136 of NCT + CCRT group and 146 of CCRT group. After PSM, 85 pairs of patients were selected. There were no significant differences in 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and recurrence-free survival (RFS) between NCT + CCRT group and CCRT group (81.0% vs. 77.5%, P = 0.750; 85.8% vs. 88.1%, P = 0.495; 92.5% vs. 93.9%, P = 0.759; 81.0% vs.77.5%, P = 0.919, respectively). Multivariate analysis found that smoking history (P = 0.044) and T classification (P = 0.027) were independent prognostic factors for OS, lymph node diameter (P = 0.032) was independent prognostic factor for LRFS, positive pretreatment lymph node condition (PLNC), which was defined as the lymph node necrosis or confluent, was independent prognostic factor for DRFS (P = 0.007), and RFS (P = 0.009). Lower 5-year OS (82.7% vs. 94.1%, P = 0.014), DRFS (79.3% vs. 96.2%, P = 0.003), and RFS (62.4% vs. 86.8%, P = 0.001) were found in positive PLNC group compared with negative PLNC group. In terms of toxicities, the incidences of acute hematological Grade 3-4 adverse events (AEs) were higher in NCT + CCRT group compared with CCRT group (P < 0.05), while no significant difference was observed in the rates of non-hematological Grade 3-4 AEs between these two groups (P > 0.05).

Conclusions: Additional NCT is not associated with improved survival outcomes for patients with stage T3-4N1 NPC, but bring increased hematological Grade 3-4 AEs. PLNC is independent prognostic factor in stage T3-4N1 NPC, with positive PLNC correlating with poor survival outcomes.

Keywords: Intensity-modulated radiotherapy; Nasopharyngeal neoplasm; Neoadjuvant chemotherapy; Prognosis.

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Conflict of interest statement

The authors declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of patients. NPC, nasopharyngeal carcinoma; NCT, neoadjuvant chemotherapy; CCRT, concurrent chemoradiotherapy
Fig. 2
Fig. 2
The Kaplan-Meier estimates of overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and recurrence-free survival (RFS) for NCT + CCRT group and CCRT group in selected 170 patients. The median follow-up in NCT + CCRT group and CCRT group were 88 months and 85 months, respectively. Overall survival (a), locoregional recurrence-free survival (b), distant recurrence-free survival (c), and recurrence-free survival (d). P-values were calculated by the unadjusted log–rank test. NCT, neoadjuvant chemotherapy; CCRT, concurrent chemoradiotherapy
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