Platinum-based concurrent chemotherapy remains the optimal regimen for nasopharyngeal carcinoma: a large institutional-based cohort study from an endemic area

• Published in: Journal of cancer research and clinical oncology Vol. 144; no. 11; pp. 2231 - 2243
• Main Authors: Yu, Yahui, Liang, Hu, Lv, Xing, Ke, Liangru, Qiu, Wenze, Huang, Xinjun, Liu, Guoying, Li, Wangzhong, Guo, Xiang, Xiang, Yanqun, Xia, Weixiong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2018; Springer Nature B.V
• Subjects: Biopsy; Cancer Research; Chemoradiotherapy; Chemotherapy; Cisplatin; Cohort analysis; Hematology; Internal Medicine; Medicine; Medicine & Public Health; Metastases; Nasopharyngeal carcinoma; Oncology; Original Article – Clinical Oncology; Patients; Platinum; Sensitivity analysis; Survival; Throat cancer; Nasopharyngeal carcinoma; Survival analysis; Propensity score analysis; Sensitivity analysis; Cisplatin-based regimen; Concurrent chemoradiotherapy
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-018-2721-6

Purpose To retrospectively investigate the optimal regimen of concurrent chemotherapy for nasopharyngeal carcinoma (NPC) by comparing clinical outcomes of patients who received platinum-based and non-platinum-based concurrent chemoradiotherapy (CCRT) regimens. Methods Based on a prospectively maintained database from 1998 to 2013 in an endemic area, a total of 4608 newly diagnosed, biopsy-proven, and non-disseminated NPC patients were identified and allocated into three cohorts based on concurrent chemotherapy regimens: cisplatin-based (CP) chemotherapy cohort, other platinum-based (OP) chemotherapy cohort, and non-platinum-based (NP) chemotherapy cohort. Overall survival (OS) and disease-free survival (DFS) were estimated using the Cox proportional hazards model and propensity score analysis of treatment using an inverse probability weighting model (PSA/IPTW). Finally, sensitivity analysis estimated the effects of potential unmeasured confounders. Results The median follow-up time was 68.5 months (range 2–194 months). The multivariate Cox model showed that NP regimens were significantly related with worse survival compared with CP or OP regimens (OS: HR 1.51, 95% CI 1.16–2.00, P  = 0.002; HR 1.68, 95% CI 1.24–2.27, P  = 0.001; DFS: HR 1.31, 95% CI 1.03–1.66, P  = 0.031; HR 1.50, 95% CI 1.14–1.97, P  = 0.004, respectively). Meanwhile, no significant survival difference was found between OP and CP regimens. The PSA/IPTW method, CCRT-specific and III–IVB NPC cohort subgroup analysis showed similar results. Sensitivity analysis confirmed the robustness of our results. Conclusions Platinum-based concurrent chemotherapy, including both CP and OP regimens, yields better survival benefits for non-metastatic NPC patients than the NP regimen and remains the optimal regimen for these patients.