Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease

James E. Han, Sun K. Yi, Steven Wang, Audrey Erman, Shethal Bearelly, Simran Sindhu, Jared R. Robbins, Julie Bauman, Charles C. Hsu

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalHead and Neck
DOIs
StateAccepted/In press - Jan 1 2019

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Drug Therapy
Survival
Histology
Multivariate Analysis
Neoplasm Micrometastasis
Propensity Score
Nasopharyngeal carcinoma
Survival Analysis
Databases
Neoplasms

Keywords

  • chemoradiation
  • head and neck cancer
  • nasopharyngeal carcinoma
  • neoadjuvant chemotherapy
  • radiation therapy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease. / Han, James E.; Yi, Sun K.; Wang, Steven; Erman, Audrey; Bearelly, Shethal; Sindhu, Simran; Robbins, Jared R.; Bauman, Julie; Hsu, Charles C.

In: Head and Neck, 01.01.2019.

Research output: Contribution to journalArticle

Han, James E. ; Yi, Sun K. ; Wang, Steven ; Erman, Audrey ; Bearelly, Shethal ; Sindhu, Simran ; Robbins, Jared R. ; Bauman, Julie ; Hsu, Charles C. / Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease. In: Head and Neck. 2019.
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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.",
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T1 - Neoadjuvant chemotherapy improves survival compared with concurrent chemoradiation alone in nasopharyngeal carcinoma patients with N3 disease

AU - Han, James E.

AU - Yi, Sun K.

AU - Wang, Steven

AU - Erman, Audrey

AU - Bearelly, Shethal

AU - Sindhu, Simran

AU - Robbins, Jared R.

AU - Bauman, Julie

AU - Hsu, Charles C.

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N2 - 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.

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