Oncotarget

Clinical Research Papers:

Implication of comorbidity on the initiation of chemotherapy and survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma

Rui Guo, Yan-Ping Mao, Lei chen, Ling-Long Tang, Guan-Qun Zhou, Li-Zhi Liu, Li Tian, Mu-Sheng Zeng, Wei-Hua Jia, Jian-Yong Shao, Ai-Hua Lin and Jun Ma _

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Oncotarget. 2017; 8:10594-10601. https://doi.org/10.18632/oncotarget.8621

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Abstract

Rui Guo1,*, Yan-Ping Mao1,*, Lei chen1, Ling-Long Tang1, Guan-Qun Zhou1, Li-Zhi Liu2, Li Tian2, Mu-Sheng Zeng3, Wei-Hua Jia3, Jian-Yong Shao4, Ai-Hua Lin5, and Jun Ma1

1 Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, People’s Republic of China

2 Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, People’s Republic of China

3 Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, People’s Republic of China

4 Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, People’s Republic of China

5 Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China

* These authors have contributed equally to this work

Correspondence to:

Jun Ma, email:

Keywords: comorbidity, Initiation of chemotherapy, nasopharyngeal carcinoma, treatment outcome

Received: September 11, 2015 Accepted: March 14, 2016 Published: April 06, 2016

Abstract

Background: To assess the impact of comorbidity on the initiation of chemotherapy and its ultimate treatment outcomes in patients with locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods: Data on 1316 patients with NPC treated between February 2003 and January 2007 was retrospectively reviewed. Comorbidity was assessed using the Adult Comorbidity Evaluation-27 (ACE-27) system. The association of various factors with chemotherapy was evaluated. And treatment outcomes of chemoradiotherapy regimes in patients with comorbidity were compared.

Results: Comorbidity was present in 42.2% of patients; mild, moderate and severe comorbidity were observed in 33.6%, 8.1% and 0.5% of patients, respectively. Comorbidity (as indicated by ACE-27 score) was a negative prognostic factor for overall survival (OS) (hazard ratio HR=1.577; P < 0.001) and disease-free survival (DFS) (HR=1.509; P < 0.001). In stage III-IV NPC, T classification, N classification, age, sex and hemoglobin before treatment were significant predictors of the initiation of chemotherapy (P < 0.05). Additionally, in stage III-IV patients with comorbidity (ACE >0), 5-year OS for the concomitant chemoradiotherapy group (CCRT) was 74.5% vs. 56.9% in the radiotherapy (RT) only group (P = 0.008), the 5-year DFS rate was 64.0% in the CCRT group vs. 49.4% for RT only (P = 0.015).

Conclusions: Comorbidity should be assessed during treatment strategy decision-making to improve survival in NPC. Concomitant chemoradiotherapy is feasible and effective in patients with comorbidity in locoregionally advanced stages.


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