局部晚期鼻咽癌辅助化疗的临床疗效分析

杨秀; 杨峤; 陈光朋; 张岸梅; 崔天祥; 钟良志; 孙建国

doi:10.16016/j.2097-0927.202204199

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局部晚期鼻咽癌辅助化疗的临床疗效分析

临床医学 | 更新时间：2026-01-09

- 局部晚期鼻咽癌辅助化疗的临床疗效分析
- Clinical efficacy of adjuvant chemotherapy for locally advanced nasopharyngeal carcinoma
- 陆军军医大学学报 2022年44卷第22期页码：2307-2316
- 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：
  
  [孙建国，E-mail: sunjg09@aliyun.com SUN Jianguo, E-mail: sunjg09@aliyun.com
- 基金信息：
  
  国家自然科学基金面上项目(81972858);重庆市科技创新领军人才支持计划(cstccx1jrc201910)
- DOI：10.16016/j.2097-0927.202204199
  中图分类号： R730.53;R739.63;R181.32
- 收稿：2022-04-26，
  
  修回：2022-07-27，
  
  纸质出版：2022-11-30
- 稿件说明：
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杨秀, 杨峤, 陈光朋, 等. 局部晚期鼻咽癌辅助化疗的临床疗效分析[J]. 陆军军医大学学报, 2022,44(22):2307-2316.

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.
杨秀, 杨峤, 陈光朋, 等. 局部晚期鼻咽癌辅助化疗的临床疗效分析[J]. 陆军军医大学学报, 2022,44(22):2307-2316. DOI： 10.16016/j.2097-0927.202204199.

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

SUNG H, FERLAY J, SIEGEL R L, et al . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J ] . CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.

LEE H M, OKUDA K S, GONZÁLEZ F E, et al . Current perspectiv es on nasopharyngeal carcinoma[J ] . Adv Exp Med Biol, 2019, 1164: 11-34. DOI: 10.1007/978-3-030-22254-3_2.

YE W M, CHANG E T, LIU Z W, et al . Development of a population-based cancer case-control study in Southern China[J ] . Oncotarget, 2017, 8(50): 87073-87085. DOI: 10.18632/oncotarget.19692.

康敏. 中国鼻咽癌放射治疗指南(2020版)[J]. 中华肿瘤防治杂志, 2021, 28(3): 167-177. DOI: 10.16073/j.cnki.cjcpt.2021.03.01.

KANG M. Chinese guideline for radiotherapy of nasopharyngeal carcinoma (2020 edition)[J]. Chin J Cancer Prev Treat, 2021, 28(3): 167-177. DOI: 10.16073/j.cnki.cjcpt.2021.03.01.

李赓, 游雁, 高健全. 尼妥珠单抗联合同步放、化疗治疗局部晚期鼻咽癌的近期疗效观察[J]. 医学理论与实践, 2019, 32(1): 56-58. DOI: 10.19381/j.issn.1001-7585.2019.01.026.

LI G, YOU Y, GAO J Q. Recent observation of the efficacy of nituzumab combined with concurrent radiotherapy and chemotherapy for locally advanced NPC[J]. J Med Theory Pract, 2019, 32(1): 56-58. DOI: 10.19381/j.issn.1001-7585.2019.01.026.

WU M Y, OU D, HU C S, et al . Comparing long-term survival and late toxicities of different sequential chemotherapy regimens with intensity-modulated radiotherapy in locore gionally advanced nasopharyngeal carcinoma[J ] . Transl Oncol, 2020, 1 3(7): 100765. DOI: 10.1016/j.tranon.2020.100765.

邱慧芝, 王琳婧, 莫浩元, 等. 905例鼻咽癌远期疗效及失败模式的探讨[J]. 肿瘤学杂志, 2018, 24(6): 555-561. DOI: 10.11735/j.issn.1671-170X.2018.06.B006.

QIU H Z, WANG L J, MO H Y, et al . Long-term outcomes and treatment failure of 905 nasopharyngeal carcinoma patients treated with radio therapy[J ] . Chin Clin Oncol, 2018, 24(6): 555-561. DOI: 10.11735/j.issn.1671-170X.2018.06.B006.

RIBASSIN-MAJED L, MARGUET S, LEE A W M, et al . What is the best treatment of locally advanced nasopharyngeal carcinoma? an individual patient data network meta-analysis[J ] . J Clin Oncol, 2017, 35(5): 498-505. DOI: 10.1200/JCO.2016.67.4119.

LEE A W M, TUNG S Y, NG W T, et al . A multicenter, phase 3, randomized trial of concurrent chemoradiotherapy plus adjuvant chemotherapy versus radiotherapy alone in patients with regionally advanced nasopharyngeal carcinoma: 10-year outcomes for efficacy and toxicity[J ] . Cancer, 2017, 123(21): 4147-4157. DOI: 10.1002/cncr.30850.

KONG M, LIM Y J, KIM Y. Concurrent chemoradiotherapy for loco-regionally advanced nasopharyngeal carcinoma: treatment outcomes and prognostic factors[J]. Asian Pac J Cancer Prev, 2018, 19(6): 1591-1599. DOI: 10.22034/APJCP.2018.19.6.1591.

WANG L J, GUO Y S, XU J H, et al . Clinical analysis of recurrence patterns in patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy[J ] . Ann Otol Rhinol Laryngol, 2017, 126(12): 789-797. DOI: 10.1177/0003489417734229.

TOMIC' K, BERIC' JOZIC' G, PARIC' A, et al . Chemobrachy radio therapy and consolidation chemotherapy in treatment of locally advanced cervical cancer: a retrospective single institution study[J ] . Wien Klin Wochenschr, 2021, 133(21/22): 1155-1161. DOI: 10.1007/s00508-021-01958-0.

TAO H Y,LIU H, HE F, et al . Adjuvant chemotherapy following combined induction chemotherapy and concurrent chemoradiotherapy improves survival in N2-3-positive nasopharyngeal carcinoma patients[J ] . J Cancer Res Clin Oncol, 2021. [Online ahead of print ] . DOI: 10.1007/s00432-021-03846-6.

CHEN Y P, LIU X, ZHOU Q, et al . Metronomic capecitabine as adjuvant therapy in locoregionally advanced nasopharyngeal carcinoma: a multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial[J ] . Lancet, 2021, 398(10297): 303-313. DOI: 10.1016/S0140-6736(21)01123-5.

CHEN L, HU C S, CHEN X Z, et al . Adjuvant chemo-therapy in patients with locoregionally advanced nasopharyngeal carcinoma: long-term results of a phase 3 multicentre randomised controlled trial[J ] . Eur J Cancer, 2017, 75: 150-158. DOI: 10.1016/j.ejca.2017.01.002.

SU L, SHE L, SHEN L F. The current role of adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma[J]. Front Oncol, 2021, 10: 585046. DOI: 10.3389/fonc.2020.585046.

HUI E P, MA B B Y, CHAN A T C. The emerging data on choice of optimal therapy for locally advanced nasopharyngeal carcinoma[J]. Curr Opin Oncol, 2020, 32(3): 187-195. DOI: 10.1097/CCO.0000000000000622.

LIU Y C, WANG W Y, TWU C W, et al . Prognostic impact of adjuvant chemotherapy in high-risk nasopharyngeal carcinoma patients[J ] . Oral Oncol, 2017, 64: 15-21. DOI: 10.1016/j.oraloncology.2016.11.008.

ZONG J F, XU H C, CHEN B J, et al . Maintenance chemo-therapy using S-1 following definitive chemoradio-therapy in patients with N3 nasopharyngeal carcinoma[J ] . Radiat Oncol, 2019, 14(1): 182. DOI: 10.1186/s13014-019-1387-9.

LIU T B, ZHENG Z H, PAN J, et al . Prognostic role of plasma Epstein-Barr virus DNA load for nasopharyngeal carcinoma: a meta-analysis[J ] . Clin Invest Med, 2017, 40(1): E1-E12. DOI: 10.25011/cim.v40i1.28049.

XUE F, HU C S, HE X Y. Long-term patterns of regional failure for nasopharyngeal carcinoma following intensity-modulated radiation therapy[J]. J Cancer, 2017, 8(6): 993-999. DOI: 10.7150/jca.17858.[PubMed]

王惠丽. 头颈部肿瘤的临床特征及预后影响因素研究[D]. 北京: 北京协和医学院, 2020.

WANG H L. Study on clinical features and prognostic factors of head and neck carcinomas[D]. Beijing: Peking Union Medical College, 2020.

LI W F, ZHANG Y, HUANG X B, et al . Prognostic value of plasma Epstein-Barr virus DNA level during posttreatment follow-up in the patients with nasopharyngeal carcinoma having undergone intensity-modulated radiotherapy[J ] . Chin J Cancer, 2017, 36(1): 87. DOI: 10.1186/s40880-017-0256-x.

LIU S L, SUN X S, LI X Y, et al . The diagnostic and pro-gnostic values of plasma Epstein-Barr virus DNA for residual cervical lymphadenopathy in nasopharyngeal carcinoma patients: a retrospective study[J ] . Cancer Commun (Lond), 2019, 39(1): 14. DOI: 10.1186/s40880-019-0357-9.

HUI E P, MA B B Y, LAM W K J, et al . Dynamic changes of post-radiotherapy plasma Epstein-Barr virus DNA in a randomized trial of adjuvant chemotherapy versus observation in nasopharyngeal cancer[J ] . Clin Cancer Res, 2021, 27(10): 2827-2836. DOI: 10.1158/1078-0432.CCR-20-3519.

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