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Prognostic Evaluation of Nasopharyngeal Carcinoma with Bone-Only Metastasis after Therapy
Jianji Pan,Tianzhu Lu,Qiaojuan Guo,Xiaofei Cui,Zhuhong Chen,Shaojun Lin,Luying Xu,Jin Lin,Jingfeng Zong 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.4
Purpose: To evaluate the prognosis of nasopharyngeal carcinoma (NPC) patients who developed bone-only metastasis after primarytreatment and the stratification of these patients into different risk groups based on independent prognostic factors. Materials and Methods: Eighty NPC patients who developed bone-only metastasis after definitive radiotherapy from October 2005to December 2010 were enrolled. All these patients received palliative treatment for bone metastasis, including chemotherapyand/or radiotherapy. Clinical features, treatment modality, and laboratory parameters were examined with univariate and multivariateanalyses. Results: The median follow-up time was 15.5 months (range, 2–67 months) for the whole cohort. The median overall metastaticsurvival (OMS) time and the 2-year estimate OMS rate were 26.5 months and 52%, respectively. Multivariate analysis indicated thatpatients with short metastases-free interval, multiple bone metastases sites, high serum lactic dehydrogenase levels, and treatedwith radiotherapy or chemotherapy alone had significantly worse outcomes. Patients were stratified into three different risk groupsbased on the number of adverse factors present. The OMS curves of the three groups were all significantly different (p<0.001). Conclusion: Severl prognostic factors were found to be associated with worse outcomes. According to the number of adverse factorspresent, bone-only metastasis patients can be stratified into three risk groups with significantly different prognoses. Suchgrouping may help in improving the design of clinical trials and in guiding individualized treatment for NPC patients with boneonlymetastasis.
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Pengjie Ji,Qiongjiao Lu,Xiaoqiang Chen,Yuebing Chen,Xiane Peng,Zhiwei Chen,Cheng Lin,Shaojun Lin,Jingfeng Zong 대한암학회 2023 Cancer Research and Treatment Vol.55 No.4
Purpose This retrospective study aimed to re-evaluate the effect of concurrent chemotherapy in patients with locally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). Materials and Methods A total of 498 patients who received neoadjuvant chemotherapy (NCT) combined with concurrent chemoradiotherapy (CCRT) or IMRT were retrospectively reviewed. The distribution of baseline characteristics was balanced using propensity score matching. Additionally, the results of NCT+IMRT and NCT+CCRT were compared using Kaplan-Meier survival analysis, and differences in survival rates were analyzed using the log rank test. Results There were no significant differences in overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LRFS) between the two groups. Patients were further categorized into risk subgroups based on pretreatment Epstein-Barr virus (EBV) DNA cutoff values using receiver operating characteristic curve analysis. There were no statistically significant differences in OS, PFS, DMFS, and LRFS between patients who received NCT+CCRT and NCT+IMRT in the high-risk group. In the low-risk group, although there were no differences between NCT+CCRT and NCT+IMRT in OS, PFS, and LRFS, patients who received NCT+CCRT had better DMFS than those who received NCT+IMRT. Conclusion Pretreatment EBV DNA level can be used to individualize concurrent chemotherapy for patients with locally advanced NPC. Patients with low pretreatment EBV DNA levels may benefit from concurrent chemotherapy, whereas those with high levels may not. Other treatment modalities need to be explored for high-risk patients to improve their prognosis.
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