Risk stratification of LA-NPC during chemoradiotherapy based on clinical classification and TVRR

Qianlong Tang; Chaorong Mei; Bei Huang; Rui Huang; Le Kang; Ailin Chen; Na Lei; Pengcheng Deng; Shouyan Ying; Peng Zhang; Yuan Qin

doi:10.1002/cam4.7029

Risk stratification of LA-NPC during chemoradiotherapy based on clinical classification and TVRR

Cancer Med. 2024 Feb;13(3):e7029. doi: 10.1002/cam4.7029.

Authors

Qianlong Tang¹, Chaorong Mei², Bei Huang³, Rui Huang⁴, Le Kang⁵, Ailin Chen⁶, Na Lei², Pengcheng Deng⁷, Shouyan Ying⁸, Peng Zhang⁴, Yuan Qin⁴

Affiliations

¹ Department of Oncology, Sichuan Mianyang 404 Hospital, First People's Hospital of Mianyang, Mianyang, China.
² Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, China.
³ Department of Oncology, Third People's Hospital of Mianyang, Mianyang, China.
⁴ Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China.
⁵ Department of Hematology and Oncology, Anyue County People's Hospital, Ziyang, China.
⁶ West China Tianfu Hospital ,Sichuan University, Chengdu, China.
⁷ Department of Oncology, Chengdu Qingbaijiang District People's Hospital, Chengdu, China.
⁸ Department of Oncology, Yunnan Cancer Hospital, Kunming, China.

Abstract

Purpose: To investigate the correlation between tumor volume reduction rate (TVRR) and prognosis in patients with diverse clinical types of nasopharyngeal carcinoma (NPC) undergoing chemoradiotherapy, thereby aptly categorizing risks and directing the personalized treatment of NPC.

Materials and methods: A total of 605 NPC patients with varying clinical types were enrolled in this study and subsequently segregated into six subgroups based on their clinical types and TVRR. To accentuate the efficacy of grouping, Groups 1-6 underwent clustered analysis of hazard atio (HR) values pertaining to progression-free survival (PFS), forming three risk clusters denoted as low, intermediate, and high. The log-rank test was employed to discern differences, and R 4.1.1 was utilized for cluster analysis.

Results: According to survival rates, we classified the first (G2 and G4), second (G1 and G6), and third (G3 and G5) risk clusters as low-, intermediate-, and high-risk, respectively. When comparing risk stratification with the 8th edition of the TNM staging system, our classification exhibited superior predictive prognostic performance. Subgroup analysis of treatments for each risk cluster revealed that the PFS in the neoadjuvant chemotherapy (NACT) + concurrent chemoradiotherapy (CCRT) group surpassed that of the CCRT group significantly (p < 0.05).

Conclusion: The reliance on clinical types and TVRR facilitates risk stratification of NPC during chemoradiotherapy, providing a foundation for physicians to tailor therapeutic strategies. Moreover, the risk cluster delineated for NPC patients during the mid-term of chemoradiotherapy stands as an independent prognostic factor for progression-free survival (PFS), overall survival (OS), distantmetastasis-free survival (DMFS), and local recurrence-free (LRRFS) posttreatment. Additionally, individuals in the high-risk cluster are recommended to undergo adjuvant chemotherapy after CCRT.

Keywords: clinical typing; nasopharyngeal carcinoma; prognosis; risk stratification; tumor volume reduction rate.

MeSH terms

Chemoradiotherapy / adverse effects
Humans
Nasopharyngeal Carcinoma / pathology
Nasopharyngeal Neoplasms* / pathology
Retrospective Studies
Risk Assessment
Tumor Burden

Grants and funding

(XZ202001ZR0064G)