Nomogram to predict the benefit of additional induction chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma: Analysis of a multicenter, phase III randomized trial

Abstract

Background and purpose: Recent clinical trials and network meta-analysis have suggested that the addition of induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) could improve survival in locoregionally advanced NPC (LANPC). We aimed to develop a nomogram to estimate the benefit of IC for individual patients based on the data from a multicenter, randomized, phase III trial (NCT01245959) comparing IC plus CCRT with CCRT alone.

Participants and methods: This study analyzed all 480 patients enrolled in the original trial. A nomogram was developed to predict 3-year failure-free survival (FFS) with or without IC.

Results: With a median follow-up of 45 months, the 3-year FFS rates were 80.3% and 72.4% in the IC plus CCRT group and CCRT group, respectively (P = 0.034). In multivariate analysis, T category, N category and treatment group were predictive of FFS and were incorporated into the nomogram. Gender was also included due to its clinical importance. This nomogram predicted that the magnitude of benefit from IC could vary significantly.

Conclusion: We developed a convenient nomogram to estimate the benefit of IC for individual patients with LANPC. This tool can serve as a catalyst of individual treatment discussions and facilitator of informed decision-making.

Keywords: Clinical trials; Induction chemotherapy; Nasopharyngeal neoplasms; Nomograms; Phase III as topic; Post hoc analysis.