Abstract
The aim of this study was to determine the prognostic value of wait time from histological diagnosis to primary treatmen for nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Between October 2009 and February 2012, a total of 1672 NPC patients were retrospectively analyzed. A cutoff value of > 4 weeks was used to define prolonged wait time. Matched patients according to the wait time were identified using propensity score matching (PSM), which was also used to identify matched patients for subsequent stratified analyses. Differences in progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS) were estimated using the Kaplan–Meier method and Cox proportional hazards models. In total, 407 pairs of NPC patients were selected by PSM. The 3-year PFS rate was significantly lower for patients with a prolonged wait time (> 4 weeks) than for those with an acceptable wait time (P = 0.035). Stratified analyses revealed that the negative effects of a prolonged wait time occurred primarily in patients with advanced NPC without neoadjuvant chemotherapy (NACT; PFS:P = 0.040; DMFS:P = 0.028). In multivariate analysis, a prolonged wait time was found to be an independent unfavorable prognostic factor for PFS and DMFS in advanced-staged patients without NACT. These results suggest that a prolonged time (> 4 weeks) between diagnosis and primary radical radiotherapy is a disadvantage for NPC patients, particularly those with advanced disease receiving no NACT. Thus, it is necessary to optimize resources for decreasing this wait time, although additional studies are warranted to further clarify our findings.
Highlights
Nasopharyngeal carcinoma (NPC) is a specific head and neck malignancy commonly observed in southern China, where the incidence is approximately 15–50 per 100,000 [1]
To the best of our knowledge, this is the first study to examine the association of the time between diagnosis and primary treatment, i.e., the wait time, with prognosis in a large population-based NPC cohort treated with intensity modulated radiation therapy (IMRT)
Using propensity score matching (PSM) and multivariate analyses, this study provides the fairest comparisons of matched patients and demonstrated higher 3-year progression-free survival (PFS) rates for NPC patients who received IMRT within 4 weeks of diagnosis than for those who received IMRT after 4 weeks
Summary
Nasopharyngeal carcinoma (NPC) is a specific head and neck malignancy commonly observed in southern China, where the incidence is approximately 15–50 per 100,000 [1]. Radiotherapy (RT) is the mainstay treatment modality for nondisseminated NPC. With the advent of intensity modulated radiation therapy (IMRT) and combined chemotherapy-RT strategies, the management of NPC has been revolutionized. IMRT offers an improved target conformity and allows safer dose escalations, greatly improving locoregional control and gradually replacing two-dimensional conventional RT as the primary RT strategy for NPC [2]. Concurrent chemoradiotherapy (CCRT) with or without adjuvant chemotherapy (AC) has been demonstrated to be the most efficacious and is recommended as a standard treatment for patients with locoregionally advanced NPC [3, 4]. Certain time-related factors such as the wait time from diagnosis to definitive RT, remain to be optimized for NPC [6]
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