Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

Xiu YANG; Qiao YANG; Guangpeng CHEN; Anmei ZHANG; Tianxiang CUI; Liangzhi ZHONG; Jianguo SUN

doi:10.16016/j.2097-0927.202204199

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Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

Clinical Medicine | 更新时间：2026-01-09

- Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma
- Journal of Army Medical University Vol. 44, Issue 22, Pages: 2307-2316(2022)
- 作者机构：
  
  1.400037 重庆, 陆军军医大学(第三军医大学)第二附属医院肿瘤科
  2.810007 西宁, 解放军第九四一医院超声诊断科
- 作者简介：
- 基金信息：
  
  the General Program of National Natural Science Foundation of China(81972858);the Science and Technology Innovative Leading Talents program of Chongqing(cstccx1jrc201910)
- DOI：10.16016/j.2097-0927.202204199
  CLC： R730.53;R739.63;R181.32
- Received：26 April 2022，
  
  Revised：2022-07-27，
  
  Published：30 November 2022
- 稿件说明：
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Xiu YANG, Qiao YANG, Guangpeng CHEN, et al. Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma[J]. Journal of Army Medical University, 2022, 44(22): 2307-2316.
DOI：

Xiu YANG, Qiao YANG, Guangpeng CHEN, et al. Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma[J]. Journal of Army Medical University, 2022, 44(22): 2307-2316. DOI： 10.16016/j.2097-0927.202204199.

摘要

目的

评价同步放化疗(concurrent chemoradiotherapy，CCRT)联合辅助化疗(adjuvant chemotherapy，AC)对局部晚期鼻咽癌(nasopharyngeal carcinoma，NPC)的临床疗效。

方法

纳入2011年4月至2019年1月在陆军军医大学第二附属医院肿瘤放疗中心初治的局部晚期NPC患者318例，根据CCRT后是否行辅助化疗分为辅助组(

=202)和未辅助组(

=116)，对比分析辅助化疗对局部晚期NPC患者的生存结局和不良反应。分层比较318例患者不同治疗方案[CCRT与CCRT+AC、诱导化疗(induction chemotherapy，IC)+CCRT与IC+CCRT+AC

]

的生存差异，分析辅助组与未辅助组配对后的99对患者在各临床指标亚组的生存差异。

结果

与单纯CCRT相比，CCRT联合辅助化疗有提高总生存时间(overall survival

OS)、无进展生存时间(progression-free survival

PFS)、无远处转移生存时间(distant metastasis-free survival

DMFS)、无复发生存时间(recurrence-free survival

RFS)的趋势；与IC+CCRT相比，辅助化疗(IC+CCRT+AC)有降低OS、PFS、DMFS、RFS的趋势。分层结果显示，辅助化疗有提高EBV阳性、N

期、ⅣA期患者OS、PFS、DMFS、RFS的趋势，有提高T

期RFS的趋势；两组患者在急性放射性黏膜炎、急性放射性咽炎和食管炎的发生上无差异；辅助组2级以上骨髓抑制发生率高于未辅助组(68%

55%

=0.020)。

结论

局部晚期NPC同步放化疗后的辅助化疗未显著增加生存获益，但对于EBV阳性、N

期、ⅣA期患者的OS、PFS、DMFS、RFS有获益趋势，对于T

期患者有RFS获益趋势。

Abstract

Objective

To evaluate the clinical efficacy of the concurrent chemoradiotherapy (CCRT) combined adjuvant chemotherapy (AC) for locally advanced nasopharyngeal carcinoma (NPC).

Methods

From April 2011 to January 2019

318 patients with locally advanced NPC were collected from radiotherapy center of the Second Affiliated Hospital of Army Medical University. According to the results of CCRT

the patients were divided into the adjuvant group and the no-adjuvant group to comparatively analyze the survival outcome and adverse reaction of those patients received adjuvant chemotherapy. Stratification analysis was used to analyze the survival difference of different therapy plans (CCRT

CCRT+AC

IC+CCRT and IC+CCRT+AC) among 318 patients. The survival difference of 99 pairs of patients in the subgroup of clinical parameters was analyzed after the patients in the adjuvant group were paired with the patients in the no-adjuvant group.

Results

Compared with CCRT

CCRT combined with adjuvant chemotherapy could increase the overall survival(OS)

progression-free survival(PFS)

distant metastasis-free survival(DMFS)and recurrence-free survival(RFS); Compared with IC plus CCRT(IC+CCRT)

IC+CCRT+AC showed a decreasing trend in OS

PFS

DMFS and RFS. According to the results of stratification analysis

for EBV positive

stage and IVA stage patients

adjuvant chemotherapy had a tendency to increase OS

PFS

DMFS and RFS

and increase the RFS for the T

stage patients. There was no difference in acute radiation mucositis

acute radiation pharyngitis and esophagitis between the two groups. The adjuvant group had higher incidence rate than the non-adjuvant group in ≥2 grade of myelosuppression(68%

55%

=0.020).

Conclusion

Adjuvant chemotherapy after concurrent chemoradiotherapy cannot significantly increase the survival benefit for patients with locally advanced NPC; For EBV positive

stage N

and stage ⅣA patients

there is a positive trend in OS

PFS

DMFS and RFS

and for stage T

patients

they also obtain benefit in PFS.

关键词

Keywords

references

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