Identifying optimal candidates for postoperative adjuvant therapy among regional persistent/recurrent nasopharyngeal carcinoma patients after neck dissection

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Purpose: To analyze the clinical outcomes of patients with regional persistent/recurrent nasopharyngeal carcinoma (NPC) who received neck dissection, and to evaluate the clinical benefit of postoperative adjuvant therapy (PAT) based on patients’ positive lymph node counts (PLNs), extracapsular spread (ECS) and preoperative plasma EBV DNA levels. Methods: From 2003 to 2017, 342 patients with regional persistent/recurrent NPC were included in this study. All patients were treated with neck dissection and 76 patients received PAT. Progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRFS) were compared between groups using propensity score matching (PSM). Results: 152 patients without PAT treatment and 76 patients with PAT treatment were selected by the PSM. There was no significant difference in 2-year PFS (52.4% vs. 61.3%, P = 0.371), 2-year OS (91.9% vs. 90.5%, P = 0.097) or 2-year LRFS (66.3% vs. 67.9%, P = 0.872) between the two groups. However, the application of PAT brought survival benefits to patients in terms of 2-year DMFS (76.5% vs. 84.7%, P = 0.020). PLN, ECS and preoperative EBV DNA level remained independent risk factors for poorer PFS. Accordingly, patients were divided into low-risk and high-risk groups using receiver operating characteristic (ROC) curve; the 2-year PFS rates for two risk groups were 73.4% and 59.1% (P < 0.0001) respectively. The results showed that low-risk patients didn’t benefit from the addition of PAT. However, the 2-year DMFS rate was significantly improved in high-risk PAT-treated patients than those treated by neck dissection alone (83.7% vs. 71.7%, P = 0.023). Conclusions: PLNs, ECS and preoperative EBV DNA level are associated with the prognosis of patients with regional persistent/recurrent NPC. High-risk patients identified by PLNs, ECS and preoperative EBV DNA level may benefit from the addition of PAT after neck dissection.
Funding Information
  • China Postdoctoral Science Foundation (2021M693645)
  • Pearl River S&T Nova Program of Guangzhou (No. 201806010135)
  • Key Youth Teacher Cultivating Program of Sun Yat-sen University (20ykzd24)
  • The National Key R&D Program of China (2017YFC0908500, 2017YFC1309003)
  • Sci-Tech Project Foundation of Guangzhou City (201707020039)
  • Sun Yat-Sen University Clinical Research 5010 Program (No.2016010, No. 201315, No.2015021, No.2017010, No. 2016013, No.2019023)
  • Innovative Research Team of High-Level Local Universities in Shanghai (SSMU-ZLCX20180500)
  • Natural Science Foundation of Guangdong Province (No.2017A030312003, No.2018A0303131004)
  • Natural Science Foundation of Guangdong Province for Distinguished Young Scholar (No. 2018B030306001)
  • Health & Medical Collaborative Innovation Project of Guangzhou City (No.201803040003)
  • Planned Science and Technology Project of Guangdong Province (2019B020230002)
  • Fundamental Research Funds for the Central Universities
  • National Natural Science Foundation of China (No. 82173287, No. 81425018, No. 81672868, No.81802775,No. 82073003, No.82002852, No. 82003267,No.81803105)

This publication has 29 references indexed in Scilit: