诱导化疗治疗≥60岁老年局部晚期鼻咽癌患者的疗效:一项单中心回顾性研究OACSTPCD

Objective:This study aims to investigate the efficacy of induction chemotherapy(IC)for elderly patients(≥60 years old)with locoregionally advanced nasopharyngeal carcinoma(LA-NPC)in the era of intensity-modulated radia-tion therapy(IMRT),select the beneficiaries from IC and identify optimal number of cycles of IC.Methods:From January 2010 to December 2020,a total of 199 elderly(≥60 years old)LA-NPC patients were collected at the General Hospital of Western Theater Command of PLA,and classified into IC group or non-IC group by the treatments they received.Propensity score matching(PSM)was performed with a ratio of 2∶1 according to age,sex,body mass index,Epstein-Barr virus infec-tion status,T and N classifications and PGTVnx.Progression-free survival(PFS)was the primary endpoint.Kaplan-Meier survival curves were applied to evaluate the PFS,overall survival(OS),distant metastasis-free survival(DMFS)and local recurrence-free survival(LRFS),and log-rank test was utilized to assess the differences between groups.Univariate and multivariate Cox regression analyses were preformed to identify factors affecting PFS.Effects of IC and different IC cycles on prognosis of elderly LA-NPC patients with different N stages were analyzed.Results:87 patients were assigned to IC group and 54 to non-IC group after PSM.In the whole elderly LA-NPC patient and the propensity-matched cohort,no significant differences were observed between IC and non-IC groups in PFS(HR=0.728,95％CI:0.468～1.132,P=0.153;HR=0.757,95％CI:0.464～1.235,P=0.260),OS(HR=0.673,95％CI:0.421～1.077,P=0.096;HR=0.728,95％CI:0.433～1.225,P=0.228),DMFS(HR=0.696,95％CI:0.389～1.245,P=0.216;HR=0.692,95％CI:0.367～1.305,P=0.249)and LRFS(HR=1.402,95％CI:0.385～5.100,P=0.606;HR=1.337,95％CI:0.345～5.179,P=0.672).Multivariate analysis indicated that N stage(N0-1 vs N2-3)and PGTVnx(＜66 Gy vs≥ 66 Gy)were correlated to PFS after PSM.Elderly LA-NPC patients after PSM were classified into T3-4N0-1 Mp groups or T1-4N2-3M0 group by the N stage.Subgroup analysis showed in the T1-4N2-3M0 group,IC led to significantly higher PFS(HR=0.562,95％CI:0.315～1.004,P=0.046)and OS(HR=0.532,95％CI:0.288～0.985,P=0.040),but didn't improve DMFS(HR=0.606,95％CI:0.299～1.227,P=0.155)and LRFS(HR=0.930,95％CI:0.154～5.606,P=0.937).While in the T3-4N0-1M0 group,PFS,OS,DMFS and LRFS were not significantly improved by IC.The ≥ 3 cycles IC regimen was po-tentially correlated to better DMFS than the 1～2 cycles IC regimen for elderly patients in the T1-4N2-3M0 group(HR=0.179,95％CI:0.024～1.363,P=0.060).Conclusion:After PSM,IC does not lead to better survival results of elderly LA-NPC patients(≥60 years old)can't benefit from IC.However,in the T1-4N2-3M0 group,IC leads to significantly higher PFS,OS,and ≥3 cycles IC regimen can potentially improve DMFS.