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Abstract
Although common, the use of chemotherapy for stage II nasopharyngeal carcinoma (NPC) is controversial due to its undefined clinical benefits. We therefore conducted a retrospective cohort study to investigate whether chemotherapy confers survival gains to stage II NPC patients. A total of 251 stage II (2010 UICC/AJCC staging system) NPC patients treated between January 2007 and December 2014 were retrospectively analyzed. Patients were matched using the propensity-score matching method. The primary endpoint was overall survival (OS). Secondary endpoints were locoregional-free survival (LRFS) and distant metastasis-free survival (DMFS). Our analyses revealed no significant differences in OS, LRFS, or DMFS for stage II NPC patients treated with radiotherapy (RT) alone, concurrent chemoradiotherapy (CCRT), or CCRT + adjuvant chemotherapy (AC). T2N1 (OR = 6.690; 95% CI, 3.091–14.481) and T1N1 (OR = 5.857; 95% CI, 2.278–15.061) patients were more likely to receive CCRT than T2N0 patients. Similarly, both T2N1 (OR = 10.513; 95% CI, 3.439–32.137) and T1N1 (OR = 7.321; 95% CI, 1.978–27.098) patients were more likely to receive CCRT + AC than T2N0 patients. The present matched survival analysis suggests potential overuse of chemotherapy in stage II NPC, as the addition of chemotherapy did not provide a survival benefit in this group of patients.
Highlights
Nasopharyngeal carcinoma (NPC) is highly endemic in southern China [1, 2]
Our analyses revealed no significant differences in overall survival (OS), locoregional-free survival (LRFS), or distant metastasis-free survival (DMFS) for stage II nasopharyngeal carcinoma (NPC) patients treated with radiotherapy (RT) alone, concurrent chemoradiotherapy (CCRT), or CCRT + adjuvant chemotherapy (AC)
Our study indicated no significant differences in OS, LRFS, and DMFS between stage II NPC patients treated with RT alone, CCRT, and CCRT + AC
Summary
Nasopharyngeal carcinoma (NPC) is highly endemic in southern China [1, 2]. Concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy (AC) is superior to radiotherapy (RT) alone in the treatment of locoregionally advanced NPC [3,4,5,6,7,8]. CCRT with or without AC is recommended for stage II NPC by the National Comprehensive Cancer Network [9], several studies suggested that chemotherapy use does not improve survival compared with RT alone [10,11,12,13,14,15,16,17]. The Chinese Anti-Cancer Association recommends RT alone for the T2N0 subgroup. It is possible that chemotherapy is overused in clinical practice without substantial survival gain.
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