Age is a significant biomarker for the selection of neoadjuvant chemotherapy plus radiotherapy versus concurrent chemoradiotherapy in patients with advanced nasopharyngeal carcinoma

Article type: Research Article

Authors: Lin, Yihong^{a; b} | Yu, Xiongbin^c | Lu, Linbin^a | Chen, Hong^d | Wu, Junxian^d | Chen, Yaying^d | Lin, Qin^d | Wang, Xuewen^d | Chen, Xi^{d; *} | Chen, Xiong^{a; *}

Affiliations: [a] Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China | [b] Fudan University Shanghai Cancer Center (Xiamen), Xianmen, Fujian, China | [c] Department of Oncology, Fuqing Hospital of Fujian Province, The Affiliated Fuqing Hospital to Fujian Medical University, Fuqing, Fujian, China | [d] Department of Oncology, The 900th Hospital of the People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China

Correspondence: [*] Corresponding authors: Xi Chen, Department of Oncology, The 900th Hospital of the People’s Liberation Army Joint Service Support Force, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China. E-mail: fuzhoucxi@163.com; Xiong Chen, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian 350025, China. E-mail: cxiongzpc@fjmu.edu.cn.

Abstract: BACKGROUND: The optimal timing of combined chemotherapy with radiotherapy for locally advanced nasopharyngeal carcinoma (LA-NPC) is undetermined. OBJECTIVE: This study aimed to compare the therapeutic efficacy of neoadjuvant chemotherapy (NACT) followed by radiotherapy (RT) and concurrent chemoradiotherapy (CCRT). METHODS: Five hundred and thirty-eight patients diagnosed with LA-NPC and treated with NACT + RT or CCRT alone were enrolled in the study. Restricted cubic spline regression (RCS) was used to determine the relationship between age and the hazard Ratio of death. A Kaplan-Meier analysis was performed to evaluate overall survival (OS) related to NACT + RT or CCRT alone. Cox proportional hazards models were used to adjust for potential confounding factors. RESULTS: Compared with the CCRT alone regimen, the NACT + RT regimen showed a significantly better OS rate with a 62% decreased risk of death in a subgroup of patients aged ⩾ 45 years (hazard ratio, HR: 0.38; 95% confidence interval, CI: 0.24–0.61). In patients aged < 45 years, the risk of death was significantly increased when NACT + RT was chosen compared with CCRT (HR: 4.10; 95% CI: 2.09–8.07). CONCLUSIONS: Age is a significant biomarker when selecting NACT + RT or CCRT alone in patients with locally advanced NPC.

Keywords: Nasopharyngeal carcinoma, neoadjuvant chemotherapy, radiotherapy, concurrent chemoradiotherapy, age

DOI: 10.3233/CBM-210357

Journal: Cancer Biomarkers, vol. 37, no. 1, pp. 1-11, 2023