Abstract
Nasopharyngeal carcinoma (NPC) is a head and neck cancer involving epithelial squamous-cell carcinoma of the nasopharynx that mainly occurs in individuals from East and Southeast Asia. We investigated whether Chinese herbal medicine (CHM) as a complementary therapy offers benefits to these patients. We retrospectively evaluated the Taiwan Cancer Registry (Long Form) database for patients with advanced NPC, using or not using CHM, between 2007–2013. Cox proportional-hazard model and Kaplan‒Meier survival analyses were applied for patient survival. CHM-users showed a lower overall and cancer-related mortality risk than non-users. For advanced NPC patients, the overall mortality risk was 0.799-fold for CHM-users, after controlling for age, gender, and Charlson comorbidity index (CCI) score (Cancer stages 3 + 4: adjusted hazard ratio [aHR]: 0.799, 95% confidence interval [CI]: 0.676–0.943, p = 0.008). CHM-users also showed a lower cancer-related mortality risk than non-users (aHR: 0.71, 95% CI: 0.53–0.96, p = 0.0273). Association rule analysis showed that CHM pairs were Ban-Zhi-Lian (BZL; Scutellaria barbata D.Don) and For single herbs, Bai-Hua-She-She-Cao (Herba Hedyotis Diffusae; Scleromitrion diffusum (Willd.) R.J.Wang (syn. Hedyotis diffusa Willd.) and Mai-Men-Dong (MMD; Ophiopogon japonicus (Thunb.) Ker Gawl.), and Gan-Lu-Yin (GLY) and BHSSC. Network analysis revealed that BHSSC was the core CHM, and BZL, GLY, and Xin-Yi-Qing-Fei-Tang (XYQFT) were important CHMs in cluster 1. In cluster 2, ShengDH, MMD, Xuan-Shen (XS; Scrophularia ningpoensis Hensl.), and Gua-Lou-Gen (GLG; Trichosanthes kirilowii Maxim.) were important CHMs. Thus, as a complementary therapy, CHM, and particularly the 8 CHMs identified, are important for the treatment of advanced NPC patients.
Highlights
Nasopharyngeal carcinoma (NPC) is a head and neck cancer involving epithelial squamous-cell carcinoma of the nasopharynx (Ferlay et al, 2019), which mainly occurs in individuals from East and Southeast Asia (Cao et al, 2011; Ferlay et al, 2019)
In the investigation of overall mortality in patients with NPC (Table 2), the crude Cox proportional hazard model revealed significant differences in age, gender, CHM use, Charlson comorbidity index (CCI) score, and cancer stage. After adjusting for these variances, the adjusted Cox proportional hazard model showed that patients aged over 60 years had a higher overall mortality risk than those aged below 50 years (Table 2; adjusted hazard ratio [aHR]: 2.36, 95% CI: 1.90–2.93, p < 0.0001)
Females showed a lower risk of overall mortality than males (Table 2; aHR: 0.73, 95% CI: 0.57–0.95, p 0.0173)
Summary
Nasopharyngeal carcinoma (NPC) is a head and neck cancer involving epithelial squamous-cell carcinoma of the nasopharynx (Ferlay et al, 2019), which mainly occurs in individuals from East and Southeast Asia (Cao et al, 2011; Ferlay et al, 2019). In Taiwan, NPC is the most and second most common head and neck cancer in males and females, respectively (Huang et al, 2015). NPC treatment involves integration of radiotherapy, chemotherapy, and surgery (Perri et al, 2019). With radiotherapy alone or chemotherapy in patients with early or advanced NPC, the 5years survival rate approaches 90% (Blanchard et al, 2015). It may cause complications (Langendijk et al, 2008; Jensen et al, 2010), such as mucositis, dermatitis, xerostomia, dysphagia, hyposalivation, xerostomia, radiation caries, sensorineural hearing loss, radioactive osteonecrosis, triceps, temporal lobe injury, and hypothyroidism. 8–10% of these patients develop therapeutic resistance and have recurrent disease and distant metastasis (Perri et al, 2011)
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