Combined prognostic value of pretreatment anemia and cervical node necrosis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: A large-scale retrospective study.

Abstract

This study investigated the combined prognostic value of pretreatment anemia and cervical node necrosis (CNN) in patients with nasopharyngeal carcinoma (NPC). Retrospective review of 1302 patients with newly diagnosed nonmetastatic NPC treated with intensity-modulated radiotherapy (IMRT) ± chemotherapy. Patients were classified into four groups according to anemia and CNN status. Survival was compared using the log-rank test. Independent prognostic factors were identified using the Cox proportional hazards model. The primary end-point was overall survival (OS); secondary end-points were disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS). Pretreatment anemia was an independent, adverse prognostic factor for DMFS; pretreatment CNN was an independent adverse prognostic factor for all end-points. Five-year survival for non-anemia and non-CNN, anemia, CNN, and anemia and CNN groups were: OS (93.1%, 87.2%, 82.9%, 76.3%, P < 0.001), DFS (87.0%, 84.0%, 73.9%, 64.6%, P < 0.001), DMFS (94.1%, 92.1%, 82.4%, 72.5%, P < 0.001), and LRRFS (92.8%, 92.4%, 88.7%, 84.0%, P = 0.012). The non-anemia and non-CNN group had best survival outcomes; anemia and CNN group, the poorest. Multivariate analysis demonstrated combined anemia and CNN was an independent prognostic factor for OS, DFS, DMFS, and LRRFS (P < 0.05). The combination of anemia and CNN is an independent adverse prognostic factor in patients with NPC treated using IMRT ± chemotherapy. Assessment of pretreatment anemia and CNN improved risk stratification, especially for patients with anemia and CNN who have poorest prognosis. This study may aid the design of individualized treatment plans to improve treatment outcomes.

• Authors: Lu-Lu Zhang, Guan-Qun Zhou, Yi-Yang Li, Ling-Long Tang, Yan-Ping Mao, Ai-Hua Lin, Jun Ma, Zhen-Yu Qi, Ying Sun
• Journal: Cancer medicine (Cancer Med) Vol. 6 Issue 12 Pg. 2822-2831 (Dec 2017) ISSN: 2045-7634 [Electronic] United States
• PMID: 29034992 (Publication Type: Journal Article)
• Copyright: © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Topics

• Adolescent
• Adult
• Aged
• Anemia (blood, complications, diagnosis, mortality)
• Carcinoma (complications, mortality, radiotherapy, secondary)
• Chi-Square Distribution
• Disease Progression
• Disease-Free Survival
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Nodes (pathology)
• Male
• Middle Aged
• Multivariate Analysis
• Nasopharyngeal Carcinoma
• Nasopharyngeal Neoplasms (complications, mortality, pathology, radiotherapy)
• Necrosis
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Proportional Hazards Models
• Radiation Tolerance
• Radiotherapy, Intensity-Modulated (adverse effects, mortality)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Young Adult