治疗及临床结局：预处理EB病毒DNA不可检测的II-IVA期鼻咽癌患者
Treatment and clinical outcomes among stage II-IVA nasopharyngeal carcinoma patients with undetectable pretreatment Epstein-Barr viral DNA.
文献信息
| PMID | 42723970 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ci-Ming Sun |
| 作者单位 | State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China. |
| 期刊 | Frontiers in medicine |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 本研究分析了多种联合化疗方案对预处理EB病毒DNA（pre-DNA）不可检测的II-IVA期鼻咽癌（NPC）患者长期生存结局的疗效。
患者与方法： 我们回顾性分析了2,440例pre-DNA不可检测的II-IVA期NPC患者。患者接受了以下任一治疗方式：单纯调强放疗（IMRT）；同步放化疗（CCRT）；诱导化疗（IC）+ CCRT；IC + IMRT；或CCRT + 辅助化疗（AC），这些患者于2009年至2015年间在中山大学肿瘤防治中心接受治疗。采用倾向性评分匹配（PSM）以平衡变量。通过比较生存结局，对不同治疗亚组中匹配后的患者进行分析。
结果： 在PSM队列中，接受IMRT联合多种化疗方案的患者与接受单纯IMRT的患者在无病生存期（DFS）、总生存期（OS）、无远处转移生存期（DMFS）或局部区域无复发生存期（LRRFS）方面均未观察到显著差异（所有P > 0.05）。估计的5年DFS、OS、DMFS和LRRFS率分别为85.6% vs. 87.3%（P = 0.33）、93.5% vs. 92.2%（P = 0.64）、94.4% vs. 93.7%（P = 0.96）和92.0% vs. 94.0%（P = 0.16）。同样，在接受IMRT联合或不联合同步化疗（CC）、IC后IMRT联合或不联合CC、或CCRT联合或不联合IC的亚组之间，5年DFS、OS、DMFS或LRRFS均未观察到显著差异。然而，在接受CCRT联合或不联合AC的患者中，未接受AC的患者5年DFS（96.0% vs. 78.3%，P = 0.004）、OS（98.0% vs. 88.1%，P = 0.027）和LRRFS（97.9% vs. 87.9%，P = 0.045）率显著更高，而DMFS未观察到显著差异（96.0% vs. 86.1%，P = 0.078）。在T3-4期和N2-3期疾病中，未发现生存结局的显著差异。
结论： 在预处理EBV DNA不可检测的II-IVA期NPC患者中，无论接受诱导化疗、同步化疗还是辅助化疗，在IMRT基础上加用化疗均与生存改善无统计学显著关联。需要进一步的前瞻性验证。
英文摘要
BACKGROUND: This study analyzed the efficacy of multiple combined chemotherapy modalities on the long-term survival outcomes in stage II-IVA nasopharyngeal carcinoma (NPC) patients with undetectable pretreatment Epstein-Barr viral DNA (pre-DNA).
PATIENTS AND METHODS: We retrospectively analyzed 2,440 patients with stage II-IVA NPC with undetectable pre-DNA. Patients received any of the following treatment modalities: intensity-modulated radiotherapy (IMRT) alone; concurrent chemoradiotherapy (CCRT); induction chemotherapy (IC) + CCRT; IC + IMRT; or CCRT + adjuvant chemotherapy (AC) at Sun Yat-sen University Cancer Center between 2009 and 2015. Propensity score matching (PSM) was performed to balance variables. Matched patients in different treatment subgroups were analyzed by comparing survival outcomes.
RESULTS: In the PSM cohorts, no significant differences were observed in disease-free survival (DFS), overall survival (OS), distant metastasis-free survival (DMFS), or locoregional relapse-free survival (LRRFS) between patients treated with IMRT combined with multiple chemotherapy modalities and those with IMRT alone (all P > 0.05). The estimated 5-year DFS, OS, DMFS, and LRRFS rates were 85.6% vs. 87.3% (P = 0.33), 93.5% vs. 92.2% (P = 0.64), 94.4% vs. 93.7% (P = 0.96), and 92.0% vs. 94.0% (P = 0.16), respectively. Similarly, no significant differences in 5-year DFS, OS, DMFS, or LRRFS were observed across subgroups receiving IMRT with or without concurrent chemotherapy (CC), IC followed by IMRT with or without CC, or CCRT with or without IC. However, among patients receiving CCRT with or without AC, the 5-year DFS (96.0% vs. 78.3%, P = 0.004), OS (98.0% vs. 88.1%, P = 0.027), and LRRFS (97.9% vs. 87.9%, P = 0.045) rates were significantly higher in patients without AC, whereas no significant difference was observed in DMFS (96.0% vs. 86.1%, P = 0.078). No significant differences in the survival outcomes of T3-4 stage and N2-3 disease were identified.
CONCLUSIONS: In patients with stage II-IVA NPC with undetectable pre-treatment EBV DNA, the addition of chemotherapy to IMRT was not associated with a statistically significant improvement in survival, regardless of whether they received induction, concurrent, or adjuvant chemotherapy. Further prospective validation is required.