To retrospectively investigate the optimal regimen of concurrent chemotherapy for nasopharyngeal carcinoma (NPC) by comparing clinical outcomes of patients who received platinum-based and non-platinum-based concurrent chemoradiotherapy (CCRT) regimens.
Based on a prospectively maintained database from 1998 to 2013 in an endemic area, a total of 4608 newly diagnosed, biopsy-proven, and non-disseminated NPC patients were identified and allocated into three cohorts based on concurrent chemotherapy regimens: cisplatin-based (CP) chemotherapy cohort, other platinum-based (OP) chemotherapy cohort, and non-platinum-based (NP) chemotherapy cohort. Overall survival (OS) and disease-free survival (DFS) were estimated using the Cox proportional hazards model and propensity score analysis of treatment using an inverse probability weighting model (PSA/IPTW). Finally, sensitivity analysis estimated the effects of potential unmeasured confounders.
The median follow-up time was 68.5 months (range 2–194 months). The multivariate Cox model showed that NP regimens were significantly related with worse survival compared with CP or OP regimens (OS: HR 1.51, 95% CI 1.16–2.00, P = 0.002; HR 1.68, 95% CI 1.24–2.27, P = 0.001; DFS: HR 1.31, 95% CI 1.03–1.66, P = 0.031; HR 1.50, 95% CI 1.14–1.97, P = 0.004, respectively). Meanwhile, no significant survival difference was found between OP and CP regimens. The PSA/IPTW method, CCRT-specific and III–IVB NPC cohort subgroup analysis showed similar results. Sensitivity analysis confirmed the robustness of our results.
Platinum-based concurrent chemotherapy, including both CP and OP regimens, yields better survival benefits for non-metastatic NPC patients than the NP regimen and remains the optimal regimen for these patients.
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The study was supported by the National Natural Science Foundation of China (Grant nos. 81572665, 81172041, 81472525); the International Cooperation Project of Science and Technology Plan of Guangdong Province (Grant nos. 2014A050503033, 2016A050502011); the Science and Technology Plan Project of Guangdong Province (Grant no. 2013B021800141); and the Foundation of Science and Technology Bureau of Guangzhou City (Grant no. 2014Y2-00179).
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. A waiver of informed consent was requested, and approval was obtained from the independent ethics committees at Sun Yat-Sen University Cancer Center.
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Kaplan-Meier survival curves for the three groups in stage III-IVB NPC cohort. (A) Overall survival, (B) Disease-free survival. NPC, nasopharyngeal carcinoma; CP group, cisplatin-based chemotherapy group; OP group, other platinum-based chemotherapy group; NP group, non-platinum chemotherapy group; CI, confidence interval; HR, hazard ratio (PDF 386 KB)
Forest plots for overall survival and disease-free survival with hazard ratios and P value by multivariate Cox proportional hazard model and IPTW/PSA in the III-IVB NPC cohort and in the III-IVB NPC, CCRT-specific cohort. NPC, nasopharyngeal carcinoma; CCRT, concurrent chemoradiotherapy; CP group, cisplatin-based chemotherapy group; OP group, other platinum-based chemotherapy group; NP group, non-platinum chemotherapy group; CI, confidence interval; HR, hazard ratio; IPTW/PSA, propensity score analysis of treatment using inverse probability weighting model (PDF 17 KB)
Kaplan-Meier survival curves for the three groups in stage III-IVB NPC, CCRT-specific cohort. (A) Overall survival, (B) Disease-free survival. NPC, nasopharyngeal carcinoma; CCRT, concurrent chemoradiotherapy; CP group, cisplatin-based chemotherapy group; OP group, other platinum-based chemotherapy group; NP group, non-platinum chemotherapy group; CI, confidence interval; HR, hazard ratio (PDF 376 KB)
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Yu, Y., Liang, H., Lv, X. et al. Platinum-based concurrent chemotherapy remains the optimal regimen for nasopharyngeal carcinoma: a large institutional-based cohort study from an endemic area. J Cancer Res Clin Oncol 144, 2231–2243 (2018). https://doi.org/10.1007/s00432-018-2721-6
- Nasopharyngeal carcinoma
- Concurrent chemoradiotherapy
- Cisplatin-based regimen
- Survival analysis
- Propensity score analysis
- Sensitivity analysis