PMID- 32615984 OWN - NLM STAT- MEDLINE DCOM- 20210401 LR - 20210401 IS - 1748-717X (Electronic) IS - 1748-717X (Linking) VI - 15 IP - 1 DP - 2020 Jul 2 TI - Can neoadjuvant chemotherapy improve survival in stage T3-4N1 nasopharyngeal carcinoma? A propensity matched analysis. PG - 160 LID - 10.1186/s13014-020-01594-4 [doi] LID - 160 AB - BACKGROUND: To estimate the efficacy of neoadjuvant chemotherapy (NCT) in stage T3-4N1 nasopharyngeal carcinoma (NPC). METHODS: Data on stage T3-4N1 NPC patients treated with concurrent chemoradiotherapy (CCRT) with or without NCT at the Sun Yat-sen University Cancer Center between January 2006 and December 2013 were retrospectively reviewed. Propensity score matching (PSM) was carried out to balance prognostic factors in NCT followed by CCRT (NCT + CCRT) group and CCRT group in a 1:1 ratio. Survival outcomes of matched patients in the two groups were compared, and prognostic factors were identified using Cox regression model. RESULTS: A total of 282 patients were involved in this study, with 136 of NCT + CCRT group and 146 of CCRT group. After PSM, 85 pairs of patients were selected. There were no significant differences in 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and recurrence-free survival (RFS) between NCT + CCRT group and CCRT group (81.0% vs. 77.5%, P = 0.750; 85.8% vs. 88.1%, P = 0.495; 92.5% vs. 93.9%, P = 0.759; 81.0% vs.77.5%, P = 0.919, respectively). Multivariate analysis found that smoking history (P = 0.044) and T classification (P = 0.027) were independent prognostic factors for OS, lymph node diameter (P = 0.032) was independent prognostic factor for LRFS, positive pretreatment lymph node condition (PLNC), which was defined as the lymph node necrosis or confluent, was independent prognostic factor for DRFS (P = 0.007), and RFS (P = 0.009). Lower 5-year OS (82.7% vs. 94.1%, P = 0.014), DRFS (79.3% vs. 96.2%, P = 0.003), and RFS (62.4% vs. 86.8%, P = 0.001) were found in positive PLNC group compared with negative PLNC group. In terms of toxicities, the incidences of acute hematological Grade 3-4 adverse events (AEs) were higher in NCT + CCRT group compared with CCRT group (P < 0.05), while no significant difference was observed in the rates of non-hematological Grade 3-4 AEs between these two groups (P > 0.05). CONCLUSIONS: Additional NCT is not associated with improved survival outcomes for patients with stage T3-4N1 NPC, but bring increased hematological Grade 3-4 AEs. PLNC is independent prognostic factor in stage T3-4N1 NPC, with positive PLNC correlating with poor survival outcomes. FAU - Wang, Lei AU - Wang L AD - VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. FAU - Wu, Zheng AU - Wu Z AD - Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283 Tong Zi Po Road, Changsha, 410013, People's Republic of China. FAU - Xie, Dehuan AU - Xie D AD - Department of Radiation Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. FAU - Lv, Shaowen AU - Lv S AD - Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. FAU - Xia, Liangping AU - Xia L AD - VIP Region, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. xialp@sysucc.org.cn. FAU - Su, Yong AU - Su Y AUID- ORCID: 0000-0002-8888-8694 AD - Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China. suyong@sysucc.org.cn. LA - eng PT - Journal Article DEP - 20200702 PL - England TA - Radiat Oncol JT - Radiation oncology (London, England) JID - 101265111 SB - IM MH - Adult MH - Aged MH - Chemoradiotherapy/adverse effects MH - Chemotherapy, Adjuvant MH - Female MH - Humans MH - Male MH - Middle Aged MH - Nasopharyngeal Carcinoma/mortality/pathology/*therapy MH - Nasopharyngeal Neoplasms/mortality/pathology/*therapy MH - Neoadjuvant Therapy MH - Neoplasm Staging MH - Prognosis MH - Propensity Score MH - Retrospective Studies PMC - PMC7331182 OTO - NOTNLM OT - Intensity-modulated radiotherapy OT - Nasopharyngeal neoplasm OT - Neoadjuvant chemotherapy OT - Prognosis COIS- The authors declared no conflicts of interest. EDAT- 2020/07/04 06:00 MHDA- 2021/04/02 06:00 PMCR- 2020/07/02 CRDT- 2020/07/04 06:00 PHST- 2020/04/02 00:00 [received] PHST- 2020/06/08 00:00 [accepted] PHST- 2020/07/04 06:00 [entrez] PHST- 2020/07/04 06:00 [pubmed] PHST- 2021/04/02 06:00 [medline] PHST- 2020/07/02 00:00 [pmc-release] AID - 10.1186/s13014-020-01594-4 [pii] AID - 1594 [pii] AID - 10.1186/s13014-020-01594-4 [doi] PST - epublish SO - Radiat Oncol. 2020 Jul 2;15(1):160. doi: 10.1186/s13014-020-01594-4.