Cargando…
Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis
BACKGROUND: The high heterogeneity of de novo metastatic nasopharyngeal carcinoma (dmNPC) makes its prognosis and treatment challenging. We aimed to accurately stage dmNPC and assess the patterns of treatment strategies for different risk groups. METHODS: The study enrolled a total of 562 patients,...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862810/ https://www.ncbi.nlm.nih.gov/pubmed/36681832 http://dx.doi.org/10.1186/s13014-022-02168-2 |
_version_ | 1784875182766161920 |
---|---|
author | Yao, Yuyi Sun, Xuesong Huang, Huageng Wang, Zhao Fang, Xiaojie Chen, Meiting Chen, Zegeng Weng, Huawei Guo, Chengcheng Hong, Huangming Huang, He Lin, Tongyu |
author_facet | Yao, Yuyi Sun, Xuesong Huang, Huageng Wang, Zhao Fang, Xiaojie Chen, Meiting Chen, Zegeng Weng, Huawei Guo, Chengcheng Hong, Huangming Huang, He Lin, Tongyu |
author_sort | Yao, Yuyi |
collection | PubMed |
description | BACKGROUND: The high heterogeneity of de novo metastatic nasopharyngeal carcinoma (dmNPC) makes its prognosis and treatment challenging. We aimed to accurately stage dmNPC and assess the patterns of treatment strategies for different risk groups. METHODS: The study enrolled a total of 562 patients, 264 from 2007 to 2013 in the training cohort and 298 from 2014 to 2017 in the validation cohort. Univariate and multivariate Cox regression analyses were conducted to determine the independent variables for overall survival (OS). Recursive partitioning analysis (RPA) was applied to establish a novel risk-stratifying model based on these variables. RESULTS: After pairwise comparisons of OS, three risk groups were generated: low-risk (involved lesions ≤ 4 without liver involvement), intermediate-risk (involved lesions ≤ 4 with liver involvement or involved lesions > 4 with Epstein–Barr virus (EBV)-DNA < 62,000 copies/ml), and high-risk (involved lesions > 4 with EBV-DNA > 62,000 copies/ml). The 3-year OS rate differed significantly between groups (80.4%, 42.0%, and 20.4%, respectively, all P < 0.05). Adding locoregional intensity-modulated radiotherapy (LRRT) followed by palliative chemotherapy (PCT) resulted in a significant OS benefit over PCT alone for the low- and intermediate-risk groups (P = 0.0032 and P = 0.0014, respectively). However, it provided no survival benefits for the high-risk group (P = 0.6). Patients did not benefit from concurrent chemotherapy during LRRT among the three subgroups (P = 0.12, P = 0.13, and P = 0.3, respectively). These results were confirmed with the validation cohort. CONCLUSIONS: The novel RPA model revealed superior survival performance in subgroup stratification and could facilitate more effective treatment strategies for dmNPC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13014-022-02168-2. |
format | Online Article Text |
id | pubmed-9862810 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98628102023-01-22 Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis Yao, Yuyi Sun, Xuesong Huang, Huageng Wang, Zhao Fang, Xiaojie Chen, Meiting Chen, Zegeng Weng, Huawei Guo, Chengcheng Hong, Huangming Huang, He Lin, Tongyu Radiat Oncol Research BACKGROUND: The high heterogeneity of de novo metastatic nasopharyngeal carcinoma (dmNPC) makes its prognosis and treatment challenging. We aimed to accurately stage dmNPC and assess the patterns of treatment strategies for different risk groups. METHODS: The study enrolled a total of 562 patients, 264 from 2007 to 2013 in the training cohort and 298 from 2014 to 2017 in the validation cohort. Univariate and multivariate Cox regression analyses were conducted to determine the independent variables for overall survival (OS). Recursive partitioning analysis (RPA) was applied to establish a novel risk-stratifying model based on these variables. RESULTS: After pairwise comparisons of OS, three risk groups were generated: low-risk (involved lesions ≤ 4 without liver involvement), intermediate-risk (involved lesions ≤ 4 with liver involvement or involved lesions > 4 with Epstein–Barr virus (EBV)-DNA < 62,000 copies/ml), and high-risk (involved lesions > 4 with EBV-DNA > 62,000 copies/ml). The 3-year OS rate differed significantly between groups (80.4%, 42.0%, and 20.4%, respectively, all P < 0.05). Adding locoregional intensity-modulated radiotherapy (LRRT) followed by palliative chemotherapy (PCT) resulted in a significant OS benefit over PCT alone for the low- and intermediate-risk groups (P = 0.0032 and P = 0.0014, respectively). However, it provided no survival benefits for the high-risk group (P = 0.6). Patients did not benefit from concurrent chemotherapy during LRRT among the three subgroups (P = 0.12, P = 0.13, and P = 0.3, respectively). These results were confirmed with the validation cohort. CONCLUSIONS: The novel RPA model revealed superior survival performance in subgroup stratification and could facilitate more effective treatment strategies for dmNPC. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13014-022-02168-2. BioMed Central 2023-01-21 /pmc/articles/PMC9862810/ /pubmed/36681832 http://dx.doi.org/10.1186/s13014-022-02168-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Yao, Yuyi Sun, Xuesong Huang, Huageng Wang, Zhao Fang, Xiaojie Chen, Meiting Chen, Zegeng Weng, Huawei Guo, Chengcheng Hong, Huangming Huang, He Lin, Tongyu Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
title | Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
title_full | Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
title_fullStr | Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
title_full_unstemmed | Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
title_short | Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
title_sort | proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862810/ https://www.ncbi.nlm.nih.gov/pubmed/36681832 http://dx.doi.org/10.1186/s13014-022-02168-2 |
work_keys_str_mv | AT yaoyuyi proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT sunxuesong proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT huanghuageng proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT wangzhao proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT fangxiaojie proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT chenmeiting proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT chenzegeng proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT wenghuawei proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT guochengcheng proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT honghuangming proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT huanghe proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis AT lintongyu proposedprognosticsubgroupsandfacilitatedclinicaldecisionmakingforadditionallocoregionalradiotherapyindenovometastaticnasopharyngealcarcinomaaretrospectivestudybasedonrecursivepartitioninganalysis |