Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease
Background Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high‐risk none...
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| Veröffentlicht in: | Head & neck 2019-12, Vol.41 (12), p.4076-4087 |
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| creator | Han, James E. Yi, Sun K. Wang, Steven Erman, Audrey Bearelly, Shethal Sindhu, Simran Robbins, Jared R. Bauman, Julie Hsu, Charles C. |
| description | Background
Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high‐risk nonendemic patients.
Methods
Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group.
Results
On MVA, NAC‐improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046).
Conclusions
NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology. |
| doi_str_mv | 10.1002/hed.25955 |
| format | Article |
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Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high‐risk nonendemic patients.
Methods
Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group.
Results
On MVA, NAC‐improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046).
Conclusions
NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.</description><identifier>ISSN: 1043-3074</identifier><identifier>EISSN: 1097-0347</identifier><identifier>DOI: 10.1002/hed.25955</identifier><identifier>PMID: 31520512</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>chemoradiation ; Chemoradiotherapy ; Chemotherapy ; Clinical trials ; Head & neck cancer ; Head and neck ; head and neck cancer ; Histology ; Multivariate analysis ; Nasopharyngeal carcinoma ; neoadjuvant chemotherapy ; radiation therapy ; Survival ; Survival analysis ; Throat cancer</subject><ispartof>Head & neck, 2019-12, Vol.41 (12), p.4076-4087</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-b9fd50bd30503fe7440c1316aa74a425bf5ec9a81ab76fe75db4e1f3a11e7e053</citedby><cites>FETCH-LOGICAL-c3535-b9fd50bd30503fe7440c1316aa74a425bf5ec9a81ab76fe75db4e1f3a11e7e053</cites><orcidid>0000-0002-0417-3879</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhed.25955$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhed.25955$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31520512$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Han, James E.</creatorcontrib><creatorcontrib>Yi, Sun K.</creatorcontrib><creatorcontrib>Wang, Steven</creatorcontrib><creatorcontrib>Erman, Audrey</creatorcontrib><creatorcontrib>Bearelly, Shethal</creatorcontrib><creatorcontrib>Sindhu, Simran</creatorcontrib><creatorcontrib>Robbins, Jared R.</creatorcontrib><creatorcontrib>Bauman, Julie</creatorcontrib><creatorcontrib>Hsu, Charles C.</creatorcontrib><title>Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease</title><title>Head & neck</title><addtitle>Head Neck</addtitle><description>Background
Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high‐risk nonendemic patients.
Methods
Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group.
Results
On MVA, NAC‐improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046).
Conclusions
NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.</description><subject>chemoradiation</subject><subject>Chemoradiotherapy</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>Head & neck cancer</subject><subject>Head and neck</subject><subject>head and neck cancer</subject><subject>Histology</subject><subject>Multivariate analysis</subject><subject>Nasopharyngeal carcinoma</subject><subject>neoadjuvant chemotherapy</subject><subject>radiation therapy</subject><subject>Survival</subject><subject>Survival analysis</subject><subject>Throat cancer</subject><issn>1043-3074</issn><issn>1097-0347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kMlOwzAURS0EomVY8APIEisWKR4bukRllKqygXX0krwQV40d7KSoH8E_4xK6ZOXp3GO9S8gFZxPOmLipsZwIPdP6gIw5m6UJkyo93O2VTCRL1YichLBijMmpEsdkJLkWTHMxJt9LdFCu-g3YjhY1Nq6r0UO7paZpvdtgoKH3G7OBNS1c04LHkn6Zro4nW_Te4z7noTTQGWcprJ1Faiy1EFxbg9_aD9zlwRfGugZoG8EYDINpKWlpAkLAM3JUwTrg-d96St4fH97mz8ni9ellfrdICqmlTvJZVWqWl5JpJitMlWIFl3wKkCpQQueVxmIGtxzydBrfdZkr5JUEzjFFpuUpuRq8ccTPHkOXrVzvbfwyE5IrPhVCi0hdD1ThXQgeq6z1ponjZJxlu-KzWHz2W3xkL_-Mfd7E2z25bzoCNwPwZda4_d-UPT_cD8ofR2mQkQ</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Han, James E.</creator><creator>Yi, Sun K.</creator><creator>Wang, Steven</creator><creator>Erman, Audrey</creator><creator>Bearelly, Shethal</creator><creator>Sindhu, Simran</creator><creator>Robbins, Jared R.</creator><creator>Bauman, Julie</creator><creator>Hsu, Charles C.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><orcidid>https://orcid.org/0000-0002-0417-3879</orcidid></search><sort><creationdate>201912</creationdate><title>Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease</title><author>Han, James E. ; Yi, Sun K. ; Wang, Steven ; Erman, Audrey ; Bearelly, Shethal ; Sindhu, Simran ; Robbins, Jared R. ; Bauman, Julie ; Hsu, Charles C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-b9fd50bd30503fe7440c1316aa74a425bf5ec9a81ab76fe75db4e1f3a11e7e053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>chemoradiation</topic><topic>Chemoradiotherapy</topic><topic>Chemotherapy</topic><topic>Clinical trials</topic><topic>Head & neck cancer</topic><topic>Head and neck</topic><topic>head and neck cancer</topic><topic>Histology</topic><topic>Multivariate analysis</topic><topic>Nasopharyngeal carcinoma</topic><topic>neoadjuvant chemotherapy</topic><topic>radiation therapy</topic><topic>Survival</topic><topic>Survival analysis</topic><topic>Throat cancer</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Han, James E.</creatorcontrib><creatorcontrib>Yi, Sun K.</creatorcontrib><creatorcontrib>Wang, Steven</creatorcontrib><creatorcontrib>Erman, Audrey</creatorcontrib><creatorcontrib>Bearelly, Shethal</creatorcontrib><creatorcontrib>Sindhu, Simran</creatorcontrib><creatorcontrib>Robbins, Jared R.</creatorcontrib><creatorcontrib>Bauman, Julie</creatorcontrib><creatorcontrib>Hsu, Charles C.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Head & neck</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Han, James E.</au><au>Yi, Sun K.</au><au>Wang, Steven</au><au>Erman, Audrey</au><au>Bearelly, Shethal</au><au>Sindhu, Simran</au><au>Robbins, Jared R.</au><au>Bauman, Julie</au><au>Hsu, Charles C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease</atitle><jtitle>Head & neck</jtitle><addtitle>Head Neck</addtitle><date>2019-12</date><risdate>2019</risdate><volume>41</volume><issue>12</issue><spage>4076</spage><epage>4087</epage><pages>4076-4087</pages><issn>1043-3074</issn><eissn>1097-0347</eissn><abstract>Background
Neoadjuvant chemotherapy (NAC) trials in endemic regions of nasopharyngeal carcinoma (NPC) found improved survival, but studies are lacking in nonendemic regions. We assessed whether adding NAC to concurrent chemoradiation (CRT) improves overall survival (OS), especially in high‐risk nonendemic patients.
Methods
Definitively treated NPC patients (n = 5424) from the National Cancer Database were analyzed for predictors of NAC and NAC effects on OS with multivariate Cox proportional hazards analysis (multivariate analysis [MVA]). Propensity score matched (1:2) survival analysis of NAC (n = 968) and CRT alone (n = 1914) was also performed. Effects on OS were stratified by risk group.
Results
On MVA, NAC‐improved OS among the total cohort (hazard ratio [HR] 0.89, P = .049), particularly among stratified keratinizing histology (HR 0.82, P = .015) and N3 disease (HR 0.73, P = .046). Among propensity matched patients, NAC improved OS in patients with N3 disease (n = 336; HR 0.71, P = .046).
Conclusions
NAC may improve OS among nonendemic NPC patients at higher risk of distant micrometastases, particularly N3 disease and those with unfavorable histology.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>31520512</pmid><doi>10.1002/hed.25955</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0417-3879</orcidid></addata></record> |
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| subjects | chemoradiation Chemoradiotherapy Chemotherapy Clinical trials Head & neck cancer Head and neck head and neck cancer Histology Multivariate analysis Nasopharyngeal carcinoma neoadjuvant chemotherapy radiation therapy Survival Survival analysis Throat cancer |
| title | Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease |
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