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Association of tumor downstaging after neoadjuvant chemotherapy with survival in patients with locally advanced nasopharyngeal carcinoma: a retrospective cohort study

  • Original Article – Cancer Research
  • Published:
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Abstract

Purpose

Assessing the downstaging effects of neoadjuvant chemotherapy (NACT) in patients with locally advanced nasopharyngeal carcinoma (LANPC) and predicting response to treatment remain challenging. The present study aimed to evaluate the long-term prognosis of downstaging after NACT in patients with LANPC and to investigate the prognostic value of post-NACT tumor downstaging on treatment outcomes in the era of concurrent chemoradiotherapy (CCRT).

Methods

This retrospective study included 226 patients with stage III (n = 188) and IVA (n = 38) NPC admitted to Haikou People’s Hospital between 1 October 2009 and 1 October 2012. The patients were grouped as downstaging or no after NACT. Overall survival (OS), locoregional failure-free survival (LFFS), and distant failure-free survival (DFFS) were analyzed.

Results

Among 226 patients, 196 (86.7%) were in the downstaging group and 30 (13.3%) were in the non-downstaging group. The longest follow-up was 76 months, and the median was 45 months. The 3-year OS rates of the downstaging group and non-downstaging group were 91.0% (95% CI 0.89–0.93) and 69.5% (95% CI 0.66–0.72) (P = 0.005). The 5-year OS rates were 81.6% (95% CI 0.78–0.86) and 53.3% (95% CI 0.49–0.61) (P = 0.001). N downstaging (3-year OS, HR 0.491, 95% CI 0.221–0.881, P = 0.022; 5-year OS, HR = 0.597, 95% CI 0.378–0.878, P = 0.021) was independently associated with OS.

Conclusion

In the treatment of LANPC, the patients with downstaging after NACT have a better prognosis than those without downstaging. This study suggests that NACT can improve the prognosis for patients with LANPC if there is downstaging.

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Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Oncology Radiotherapy, Hainan Cancer Hospital, 4 th west Street of ChangBin Road, Haikou, 570311, China

    Weifeng Wang, Shaohua Peng, Huanliang Wu & Yunxiu Luo

  2. Department of Radiation Oncology, Haikou Municipal Hospital, Haikou, China

    Feng Yuan, Zhiren Lin, Gang Cheng & Shengmin Chen

Authors
  1. Weifeng Wang
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  2. Shaohua Peng
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  3. Huanliang Wu
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  4. Yunxiu Luo
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  5. Feng Yuan
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  7. Gang Cheng
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  8. Shengmin Chen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ZL, GC, and SC. The first draft of the manuscript was written by WW, HW, YL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Weifeng Wang.

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The authors declare that they have no competing interests.

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This study was approved by the Ethics Committee of Haikou People’s Hospital (Ethics Review Approval Number: 2009-(ER)-082).

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The requirement for informed consent was waived by the committee.

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Wang, W., Peng, S., Wu, H. et al. Association of tumor downstaging after neoadjuvant chemotherapy with survival in patients with locally advanced nasopharyngeal carcinoma: a retrospective cohort study. J Cancer Res Clin Oncol 147, 2913–2922 (2021). https://doi.org/10.1007/s00432-021-03690-8

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