局部晚期鼻咽癌中两周期与三周期诱导化疗的疗效和毒性比较：一项倾向性评分匹配分析
Comparative efficacy and toxicity of two versus three induction chemotherapy cycles in locally advanced nasopharyngeal carcinoma: a propensity score matching analysis.
文献信息
| PMID | 42958105 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Renxian Xie |
| 作者单位 | Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, 515031, P.R. China. |
| 期刊 | BMC cancer |
| SCI 分区 | Q2 |
| IF | 4.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 对于局部晚期鼻咽癌（LA-NPC）患者，诱导化疗（IC）的最佳周期数仍不确定。本研究旨在评估不同周期IC在LA-NPC患者中的疗效和毒性。
方法： 这项回顾性研究纳入210例LA-NPC患者，比较两组患者的临床结局和毒性：129例接受两周期IC联合同步放化疗（CCRT），81例接受三周期IC联合CCRT。采用倾向性评分匹配以减少选择偏倚并提高两个队列的可比性。采用Kaplan-Meier曲线、log-rank检验和Cox比例风险回归分析进行生存分析。
结果： 倾向性评分匹配识别出81对匹配患者。两周期组与三周期组在5年总生存（OS）率（88.1% vs. 80.4%，p = 0.21）、5年局部区域无复发生存（LRRFS）率（91.8% vs. 94.7%，p = 0.51）、5年无远处转移生存（DMFS）率（80.9% vs. 84.8%，p = 0.55）或5年无进展生存（PFS）率（73.4% vs. 79.7%，p = 0.4）方面均未观察到显著差异。然而，三周期组的3/4级治疗相关急性毒性发生率更高，差异在CCRT期间显著，但在IC期间不显著。多因素分析确定IVa期为OS的独立预后因素，而LDH水平 ≥ 245 U/L为DMFS和PFS较差的独立预测因素。
结论： 对于LA-NPC患者，与两周期IC相比，三周期IC并未显著改善患者生存，反而增加了毒性发生率。
英文摘要
BACKGROUND: For patients with locally advanced nasopharyngeal carcinoma (LA-NPC), the optimal number of cycles of induction chemotherapy (IC) remains uncertain. This study aimed to assess the efficiency and toxicity of different cycles of IC in LA-NPC patients.
METHODS: This retrospective study included 210 patients with LA-NPC and compared clinical outcomes and toxicity in two groups: 129 patients received two cycles of IC plus concurrent chemoradiotherapy (CCRT), and 81 patients received three cycles of IC plus CCRT. Propensity score matching was employed to mitigate selection bias and enhance the comparability of the two cohorts. Survival analysis was conducted using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression analyses.
RESULTS: Propensity score matching identified 81 matched pairs of patients. No significant differences were observed between the two-cycle and three-cycle groups regarding 5-year overall survival (OS) rates (88.1% vs. 80.4%, p = 0.21), 5-year locoregional relapse-free survival (LRRFS) rates (91.8% vs. 94.7%, p = 0.51), 5-year distant metastasis-free survival (DMFS) rates (80.9% vs. 84.8%, p = 0.55), or 5-year progression-free survival (PFS) rates (73.4% vs. 79.7%, p = 0.4). However, the three-cycle group had a greater incidence of grade 3/4 treatment-related acute toxicity, with the difference being significant during CCRT but not IC. Multivariate analysis identified stage IVa as an independent prognostic factor for OS, while LDH levels ≥ 245 U/L were independent predictors of poorer DMFS and PFS.
CONCLUSION: For patients with LA-NPC, three cycles of IC did not significantly improve patients' survival compared to two cycles of IC but rather increased the incidence of toxicity.