Decreased Overall and Cancer-Specific Mortality with Neoadjuvant Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma Treated by Intensity-modulated Radiotherapy: Multivariate Competing Risk Analysis

Background: Value of neoadjuvant chemotherapy (NACT) is still controversial in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Based on competing risk analysis model, we aim at evaluating the efficacy of NACT in decreasing cancer-specific mortality for LA-NPC (except T3-4N0) treated by intensity-modulated radiotherapy (IMRT). Methods: Data on 957 patients with LA-NPC were retrospectively reviewed. The cumulative incidence of cancer-specific and non-cancer-specific (competing) mortality was determined by univariate and multivariate competing risk analysis. Results: 542 (56.6%) patients received NACT using docetaxel with cisplatin (TP) or fluorouracil with cisplatin (PF) regimens. The median follow-up duration was 57.23 months (range, 1.27-78.53 months). In total, 161/957 (16.8%) patients died, with 140 cancer-specific and 21 non-cancer-specific deaths were observed, respectively. In univariate analysis, the 3- and 5-year cumulative cancer-specific mortality rates for NACT vs. non-NACT group were 8.58% vs. 7.32% and 14.74% vs. 14.52% (P = 0.95), respectively. With regard to competing mortality, the 3- and 5-year cumulative rates (0.93% vs. 1.22% and 1.31% vs. 3.06%; P = 0.196) were comparable between the two groups. Multivariate competing risk analysis established NACT as an independent prognostic factor in decreasing cancer-specific mortality (HR, 0.681; 95% CI, 0.488-0.951; P = 0.016) and overall mortality (HR, 0.654; 95% CI, 0.471-0.909; P = 0.011). Conclusions: NACT may be a powerful approach in decreasing cancer-specific mortality and overall mortality in LA-NPC treated by IMRT, and our findings would strengthen the role of NACT.