Abstract
ObjectTo ascertain the treatment effect of concurrent chemotherapy (CCT) in stage II‐III nasopharyngeal carcinoma (NPC) patients with different Epstein‐Barr virus (EBV) DNA level in intensity‐modulated radiotherapy (IMRT) era.MethodsA total of 2742 patients diagnosed with stage II‐III NPC were involved in this study. Patients received IMRT with/without CCT. Overall survival (OS) was the primary endpoint. Receiver operating characteristics curve was used to determine the cut‐off value of pre‐DNA based on OS. After propensity score matching, the role of CCT was explored in patients with different EBV DNA level.ResultsIn our cohort, the cut‐off value of pre EBV DNA was 1460 copies/mL (area under curve [AUC], 0.695‐0.769; sensitivity, 0.766; specificity, 0.599). Patients with high EBV DNA level showed poor survival in OS, progression free survival (PFS), locoregional relapse‐free survival (LRFS) and distant metastasis‐free survival (DMFS). In patients with EBV DNA level >1460 copies/mL, the concurrent chemoradiotherapy (CCRT) group achieved higher 3‐year OS compared with IMRT groups. However, the CCRT and IMRT groups showed comparable OS in patients with EBV DNA ≤1460 copies/mL. In multivariate analyses, CCT was a protective factor for OS, PFS, and LRFS in high‐risk patients (EBV DNA level >1460 copies/mL), while not an independent prognostic factor among the low‐risk patients (EBV DNA level ≤1460 copies/mL).ConclusionPre‐EBV DNA could be a useful tool to guide individualized treatment for stage II‐III NPC patients. Additional CCT to IMRT improved the survival for patients with high pre‐EBV DNA, while those with low pre‐EBV DNA could not.
Highlights
Nasopharyngeal cancer (NPC) is an uncommon cancer, with an estimated 86,700 new cases in 2012, accounting for 0.6% of all cancers in China.[1]
We carried out a retrospective analysis using a large cohort and long duration of follow‐up to identify the prognostic value of pre‐Epstein‐Barr virus (EBV) DNA level for risk stratification among stage II‐III NPC patients and selected the candidates that might benefit from concurrent chemoradiotherapy (CCRT)
This is the first study to explore the role of concurrent chemotherapy (CCT) among stage II‐III NPC patients based on the pre‐EBV DNA level with a large cohort
Summary
This work was supported by grants from the National Key R&D Program of China (2017YFC0908500, 2017YFC1309003), the National Natural Science Foundation of China (No 81425018, 81672868, 81602371), the Sun Yat Sen University Clinical Research 5010 Program (201707020039, 2014A020212103, 16zxyc02), the Sci‐Tech Project Foundation of Guangzhou City (201707020039), the National Key Basic Research Program of China (No 2013CB910304), the Special Support Plan of Guangdong Province (No 2014TX01R145), the Sci‐Tech Project Foundation of Guangdong Province (No 2014A020212103), the Health & Medical Collaborative Innovation Project
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