Whether Primary Bone-Only Oligometastatic Nasopharyngeal Carcinoma Patients Benefit From Radiotherapy to the Bones on the Basis of Palliative Chemotherapy Plus Locoregional Radiotherapy?—A Large-Cohort Retrospective Study

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2024-11-04 DOI:10.1002/cam4.70315

Wan-Ping Guo, Guo-Dong Jia, Si-Yi Xie, Xuan Yu, Xiao-Han Meng, Lin-Quan Tang, Xiao-Yun Li, Dong-Hua Luo

{"title":"Whether Primary Bone-Only Oligometastatic Nasopharyngeal Carcinoma Patients Benefit From Radiotherapy to the Bones on the Basis of Palliative Chemotherapy Plus Locoregional Radiotherapy?—A Large-Cohort Retrospective Study","authors":"Wan-Ping Guo, Guo-Dong Jia, Si-Yi Xie, Xuan Yu, Xiao-Han Meng, Lin-Quan Tang, Xiao-Yun Li, Dong-Hua Luo","doi":"10.1002/cam4.70315","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Whether to perform local radiotherapy on metastatic bone for primary bone-only oligometastatic nasopharyngeal carcinoma (NPC) patients remains unclear. Therefore, we analyzed the treatment methods and their survival and developed a prognostic model to predict outcomes and guide personalized treatment.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>We studied 308 primary bone-only oligometastatic NPC patients who were treated with either palliative chemotherapy (PCT) alone, PCT combined with locoregional radiotherapy (LRRT), or PCT, LRRT, and radiotherapy to metastatic bones (bRT). The primary endpoint was overall survival (OS). Cox regression was utilized to identify independent prognostic factors, leading to the construction of a nomogram model. Patients were stratified into two risk groups based on median prognostic scores, and treatment modalities were compared using log-rank test while employing the inverse probability of treatment weighting (IPTW) to balance baseline characteristics and adjust for sample size differences between risk groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The best OS was observed in the group treated with PCT, LRRT, and bRT (HR = 0.60, 95% CI: 0.45–0.81, <i>p</i> = 0.002). Multivariable analysis revealed that age, N stage, pre-treatment levels of LDH, and EBV DNA were independent prognostic factors for OS. In total, 155 patients were in low-risk group while 153 were in high-risk group. Before and after IPTW, the high-risk group benefited from the PCT, LRRT, and bRT regimen (adjusted HR = 0.53, 95% CI: 0.42–0.67, <i>p</i> < 0.001; unadjusted HR = 0.59, 95% CI: 0.42–0.83, <i>p</i> = 0.007), while the low-risk group did not (adjusted HR = 0.79, 95% CI: 0.56–1.11, <i>p</i> = 0.345; unadjusted HR = 0.65, 95% CI: 0.37–1.14, <i>p</i> = 0.309).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Best outcomes of the whole cohort were seen with PCT + LRRT + bRT. Our study identified age, N stage, pre-treatment LDH levels, and EBV DNA levels as independent prognostic factors for OS. The high-risk group demonstrated a longer OS when treated with PCT + LRRT + bRT, whereas the low-risk group did not benefit from the combinatorial treatment.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"13 21","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70315","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cam4.70315","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

Whether to perform local radiotherapy on metastatic bone for primary bone-only oligometastatic nasopharyngeal carcinoma (NPC) patients remains unclear. Therefore, we analyzed the treatment methods and their survival and developed a prognostic model to predict outcomes and guide personalized treatment.

Materials and Methods

We studied 308 primary bone-only oligometastatic NPC patients who were treated with either palliative chemotherapy (PCT) alone, PCT combined with locoregional radiotherapy (LRRT), or PCT, LRRT, and radiotherapy to metastatic bones (bRT). The primary endpoint was overall survival (OS). Cox regression was utilized to identify independent prognostic factors, leading to the construction of a nomogram model. Patients were stratified into two risk groups based on median prognostic scores, and treatment modalities were compared using log-rank test while employing the inverse probability of treatment weighting (IPTW) to balance baseline characteristics and adjust for sample size differences between risk groups.

Results

The best OS was observed in the group treated with PCT, LRRT, and bRT (HR = 0.60, 95% CI: 0.45–0.81, p = 0.002). Multivariable analysis revealed that age, N stage, pre-treatment levels of LDH, and EBV DNA were independent prognostic factors for OS. In total, 155 patients were in low-risk group while 153 were in high-risk group. Before and after IPTW, the high-risk group benefited from the PCT, LRRT, and bRT regimen (adjusted HR = 0.53, 95% CI: 0.42–0.67, p < 0.001; unadjusted HR = 0.59, 95% CI: 0.42–0.83, p = 0.007), while the low-risk group did not (adjusted HR = 0.79, 95% CI: 0.56–1.11, p = 0.345; unadjusted HR = 0.65, 95% CI: 0.37–1.14, p = 0.309).

Conclusion

Best outcomes of the whole cohort were seen with PCT + LRRT + bRT. Our study identified age, N stage, pre-treatment LDH levels, and EBV DNA levels as independent prognostic factors for OS. The high-risk group demonstrated a longer OS when treated with PCT + LRRT + bRT, whereas the low-risk group did not benefit from the combinatorial treatment.

Abstract Image

查看原文本刊更多论文

在姑息化疗和局部放疗的基础上对骨骼进行放疗是否有利于原发性单纯骨转移鼻咽癌患者？

目的：对于原发性骨寡转移性鼻咽癌（NPC）患者，是否对转移骨进行局部放疗仍不清楚。因此，我们分析了治疗方法及其生存率，并建立了一个预后模型，以预测预后并指导个性化治疗：我们研究了308例原发性骨少转移性鼻咽癌患者，他们分别接受了姑息化疗（PCT）、PCT联合局部放疗（LRRT）或PCT、LRRT和转移骨放疗（bRT）治疗。主要终点是总生存期（OS）。利用 Cox 回归确定独立的预后因素，从而构建了一个提名图模型。根据预后评分的中位数将患者分为两个风险组，采用对数秩检验比较治疗方式，同时采用反向治疗概率加权法（IPTW）平衡基线特征并调整风险组间的样本量差异：PCT、LRRT 和 bRT 治疗组的 OS 最佳（HR = 0.60，95% CI：0.45-0.81，p = 0.002）。多变量分析显示，年龄、N 分期、治疗前 LDH 水平和 EBV DNA 是影响 OS 的独立预后因素。共有155名患者属于低危组，153名患者属于高危组。在IPTW治疗前后，高危组均从PCT、LRRT和bRT治疗方案中获益（调整后HR=0.53，95% CI：0.42-0.67，p）：整个队列中，PCT + LRRT + bRT 的疗效最佳。我们的研究发现，年龄、N分期、治疗前LDH水平和EBV DNA水平是影响OS的独立预后因素。高风险组在接受PCT + LRRT + bRT治疗后，OS时间更长，而低风险组并没有从联合治疗中获益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.