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Comparison of induction chemotherapy combined with concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in Lymph-Node-Stage Nasopharyngeal Carcinoma based on propensity score-matching

  • Zhi-Cheng Liu
    Affiliations
    Department of Oncology, The Second Affiliated Hospital of Nanchang University

    Medical College of Nanchang University
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  • Ke-Hao Zeng
    Affiliations
    Medical College of Nanchang University
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  • Zhen-Bang Gu
    Affiliations
    Medical College of Nanchang University
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  • Run-Pu Chen
    Affiliations
    Medical College of Nanchang University
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  • Yi-Jing Luo
    Affiliations
    Medical College of Nanchang University
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  • Lin-Quan Tang
    Affiliations
    Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center

    State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine

    Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy
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  • Kai-Bin Zhu
    Affiliations
    Department of Oncology, The Second Affiliated Hospital of Nanchang University

    Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, P. R. China

    NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Jiangxi Cancer Hospital of Nanchang University
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  • Yan Liu
    Affiliations
    Department of Oncology, The Second Affiliated Hospital of Nanchang University

    Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, P. R. China

    NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Jiangxi Cancer Hospital of Nanchang University
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  • Author Footnotes
    1 These authors are both corresponding authors
    Xue-Song Sun
    Correspondence
    Corresponding authors at: Department of Oncology, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Donghu District, Nanchang 330008, P. R. China
    Footnotes
    1 These authors are both corresponding authors
    Affiliations
    Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center

    State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine

    Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy
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  • Author Footnotes
    1 These authors are both corresponding authors
    Lei Zeng
    Correspondence
    Corresponding authors at: Department of Oncology, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Donghu District, Nanchang 330008, P. R. China
    Footnotes
    1 These authors are both corresponding authors
    Affiliations
    Department of Oncology, The Second Affiliated Hospital of Nanchang University

    Jiangxi Key Laboratory of Clinical Translational Cancer Research, Nanchang, P. R. China

    NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Jiangxi Cancer Hospital of Nanchang University
    Search for articles by this author
  • Author Footnotes
    1 These authors are both corresponding authors
Published:November 18, 2022DOI:https://doi.org/10.1016/j.radonc.2022.11.010

      Abstract

      Purpose

      To explore the role of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone in patients diagnosed with N3 nasopharyngeal carcinoma (NPC).

      Patients and methods

      A total of 787 patients with newly diagnosed N3 NPC treated with IC + CCRT or CCRT alone were included. Progression-free survival (PFS) was the primary endpoint. We balanced variables using propensity score matching (PSM). Kaplan–Meier curves with log-rank tests were applied to evaluate the survival condition of each group. Independent prognostic factors were identified using the Cox regression analysis.

      Results

      PSM assigned 228 patients to IC + CCRT and CCRT alone groups. Survival analysis for the matched data set showed that IC + CCRT achieved better survival outcomes compared with CCRT alone, and significant difference was observed in 5-year PFS [74.8% (95%CI 69.2∼80.9 %) vs. 65.4% (95%CI 59.4∼72.0 %), P = 0.008], 5-year OS [(77.4%(95%CI 71.9∼83.3 %) vs.66.3%(95%CI 60.3∼72.9 %), P = 0.005)] and 5-year distant metastasis-free survival (DMFS)[(81.8%(95%CI 76.7∼87.2 %) vs.72.4%(95%CI 66.7∼78.7 %), P = 0.007)] between the two treatment groups. In multivariate analysis, IC + CCRT remained an independent protective factor for PFS (adjusted HR, 0.603; 95% CI, 0.433-0.841; P = 0.003), OS (adjusted HR, 0.568; 95% CI, 0.406-0.793; P < 0.001), and DMFS (adjusted HR, 0.541; 95% CI, 0.364-0.805; P = 0.002).

      Conclusion

      More chemotherapy should be considered in patients with N3 NPC because of its ability to improve survival time. This could be from the use of IC or adjuvant metronomic chemotherapy.

      Keywords

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