Risk stratification of LANPC during chemoradiotherapy based on clinical classification and TVRR

Author:

Tang Qianlong12ORCID,Mei Chaorong3,Huang Bei4,Huang Rui1,Kang Le5,Chen Ailin6,lei Na3,Deng Pengcheng7,Ying Shouyan8,Zhang Peng1,Qin Yuan1

Affiliation:

1. Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Afffliated Cancer Hospital of University of Electronic Science and Technology of China Chengdu China

2. Department of Oncology Sichuan Mianyang 404 Hospital, First People's Hospital of Mianyang Mianyang China

3. Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (Hospital.C.T.) Chengdu China

4. Department of Oncology Third People's Hospital of Mianyang Mianyang 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

AbstractPurposeTo 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 MethodsA 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.ResultsAccording 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).ConclusionThe 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.

Publisher

Wiley

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