Outcomes of Adding Induction Chemotherapy to Concurrent Chemotherapy for Nasopharyngeal Carcinoma Patients with Moderate-Risk in the Intensity-Modulated Radiotherapy Era

Figures & data

Table 1 Baseline Characteristics of the Patients with Stage T1-2N1M0 or T3-4N0-1M0 Nasopharyngeal Carcinoma

Characteristic	IC + CCRT	CCRT	P
	n = 203 (40.1%)	n = 303 (59.9%)
Gender			0.364
Male	147 (72.4%)	208 (68.6%)
Female	56 (27.6%)	95 (31.4%)
Age (years)			0.302
<45	114 (56.2%)	156 (51.5%)
≥45	89 (43.8%)	147 (48.5%)
T category			<0.001
1	12 (5.9%)	27 (8.9%)
2	16 (7.9%)	49 (16.2%)
3	81 (39.9%)	154 (50.8%)
4	94 (46.3%)	73 (24.1%)
N category			0.862
0	31 (15.3%)	48 (15.8%)
1	172 (84.7%)	255 (84.2%)
Clinical stage			<0.001
II	28 (13.8%)	78 (25.1%)
III	82 (39.9%)	152 (50.8%)
IV a	93 (46.3%)	73 (24.1%)
EBV DNA			<0.001
<4000 copies/mL	73 (36.0%)	186 (61.4%)
≥4000 copies/mL	130 (64.0%)	117 (38.6%)

Abbreviations: IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy; EBV DNA, Epstein-Barr virus deoxyribonucleic acid.

Figure 1 Kaplan–Meier survival curves for patients with stage T1-2N1M0 or T3-4N0-1M0 nasopharyngeal carcinoma treated with IC + CCRT or CCRT alone. (A) Overall survival; (B) progression-free survival; (C) locoregional relapse-free survival; (D) distant metastasis-free survival.

Abbreviations: IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy; NPC, nasopharyngeal carcinoma.

Table 2 Summary of Multivariable Analyses of Prognostic Factors

Endpoint	Variable	HR (95% CI)	P
OS	Age*	1.04 (1.01–1.06)	0.003
	Gender†	1.12 (0.67–1.86)	0.660
	EBV DNA‡	1.34 (0.81–2.22)	0.253
	T3 vs T1-2	0.77 (0.34–1.75)	0.530
	T4 vs T1-2	1.62 (0.72–3.61)	0.243
	N1 vs N0	1.09 (0.57–2.07)	0.794
	IC + CCRT vs CCRT	0.76 (0.46–1.25)	0.278
PFS	Age*	1.02 (0.79–1.83)	0.032
	Gender†	1.20 (0.79–1.83)	0.387
	EBV DNA‡	1.29 (0.86–1.96)	0.221
	T3 vs T1-2	0.81 (0.44–1.50)	0.498
	T4 vs T1-2	1.59 (0.86–2.92)	0.139
	N1 vs N0	0.88 (0.52–1.47)	0.619
	IC + CCRT vs CCRT	0.78 (0.51–1.19)	0.244
LRFS	Age*	1.00 (0.97–1.03)	0.917
	Gender^†	1.42 (0.81–2.48)	0.219
	EBV DNA^‡	1.37 (0.78–2.42)	0.278
	T3 vs T1-2	0.47 (0.22–1.00)	0.050
	T4 vs T1-2	0.78 (0.37–1.67)	0.529
	N1 vs N0	0.66 (0.32–1.32)	0.237
	IC + CCRT vs CCRT	1.06 (0.81–1.42)	0.651
DMFS	Age*	1.01 (0.98–1.04)	0.340
	Gender^†	0.66 (0.35–1.23)	0.190
	EBV DNA^‡	2.19 (1.24–3.85)	0.007
	T3 vs T1-2	0.75 (0.37–1.52)	0.427
	T4 vs T1-2	0.83 (0.39–1.76)	0.625
	N1 vs N0	1.39 (0.61–3.13)	0.433
	IC + CCRT vs CCRT	0.66 (0.38–1.15)	0.140

Notes: P-values were calculated using an adjusted Cox proportional hazards model. *Age per year increase. ^†Women vs men. ^‡≥4000 vs <4000 copies/mL.

Abbreviations: HR, hazard ratio; CI, confidence interval; EBV DNA: Epstein-Barr virus deoxyribonucleic acid; OS, overall survival; PFS, progression-free survival; LRFS, locoregional relapse-free survival; DMFS, distant metastasis-free survival; IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy.

Figure 2 Kaplan–Meier survival curves for patients with stage T1-2N1M0 or T3-4N0-1M0 nasopharyngeal carcinoma treated with IC + CCRT or CCRT alone stratified by N category. (A and C) Overall survival; (B and D) distant metastasis-free survival.

Abbreviations: IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy; NPC, nasopharyngeal carcinoma.

Figure 3 Kaplan–Meier survival curves for patients with stage T1-2N1M0 or T3-4N0-1M0 nasopharyngeal carcinoma treated with IC + CCRT or CCRT alone and stratified by EBV DNA copy number (≥4000 vs <4000 copies/mL). (A and C) Overall survival; (B and D) distant metastasis-free survival.

Abbreviations: IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy; NPC, nasopharyngeal carcinoma; EBV DNA, Epstein-Barr virus deoxyribonucleic acid.

Table 3 Subgroup Analysis of the Prognostic Value of Induction Chemotherapy

	OS				DMFS
	Number of Events	Total Number	5-Year OS	P	Number of Events	Total Number	5-Year DMFS	P
TPF Regimen IC
IC + CCRT	12	95	89.1%	0.739	10	95	89.0%	0.593
CCRT alone	43	303	86.8%		38	303	88.0%
TP or PF Regimen IC
IC + CCRT	16	108	88.2%	0.720	12	108	90.5%	0.449
CCRT alone	43	303	86.8%		38	303	88.0%
T1-2N1M0
IC + CCRT	3	28	91.6%	0.706	4	28	82.9%	0.724
CCRT alone	5	76	86.3%		8	76	87.5%
T3-4N0-1M0
IC + CCRT	25	175	88.2%	0.486	18	175	90.6%	0.309
CCRT alone	38	227	86.1%		30	227	88.1%

Notes: TPF was 60 mg/m² docetaxel on day 1, 60 mg/m² cisplatin on day 1 and 600 mg/m²/d fluorouracil civ on days 1–5; TP was 75 mg/m² docetaxel on day 1 and 75 mg/m² cisplatin on day 1; PF was 80 mg/m² cisplatin on day 1 and 800 mg/m²/d fluorouracil civ on days 1–5. P-values were calculated using the Log-rank test.

Abbreviations: OS, overall survival; DMFS, distant metastasis-free survival; IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy.