Regular aspirin intake and prognosis of TxN2-3M0 nasopharyngeal carcinoma: A cohort study based on propensity score matching

Abstract

Distant metastasis is the leading cause of death in patients with N2-3 nasopharyngeal carcinoma (NPC). And aspirin is found to reduce metastasis and improve prognosis in some other malignancies, such as colorectal cancer. This study aimed to evaluate the clinical value of regular aspirin intake (RAI) in N2-3 NPC treated with standard chemoradiotherapy. Totally 2064 patients diagnosed with TxN2-3M0 NPC from Jan. 2008 to Dec. 2015 and treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy were involved. According to RAI, these patients were divided into 2 groups between which a propensity score matching was made, with a ratio of 1:3 and a series of clinical characteristics (age, gender, T stage, N stage and EBV DNA) as covariates. Then survivals and acute toxicities were compared in the 464 matched patients. RAI appeared to bring better overall (87.7% vs. 79.6%, P=0.031), metastasis-free (87.8% vs. 76.5%, P=0.017) and disease-free (85.9% vs. 75.5%, P=0.033) survivals. It simultaneously increased total incidences of myelosuppression (55.2% vs. 32.2%, P<0.001), oral mucositis (60.3% vs. 38.2%, P<0.001), cervical dermatitis (60.3% vs. 38.5%, P<0.001) and xerostomia (49.1% vs. 33.3%, P=0.002). But RAI failed to affect incidence of any grade 3/4 toxicity. Post-diagnosis RAI might be a tolerable approach to control distant metastasis and provide survival benefit for N2-3 NPC in combination with standard chemoradiotherapy.