A novel scoring model to predict benefit of additional induction chemotherapy to concurrent chemoradiotherapy in stage II-IVa nasopharyngeal carcinoma.
OBJECTIVES
Induction chemotherapy (IC) is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). We aimed to develop a model to predict benefit from additional IC to concurrent chemoradiotherapy (CCRT).


MATERIALS AND METHODS
From an NPC-specific database, 7413 patients with stage II-IVa disease who received CCRT with or without IC were included. Distant metastasis-free survival (DMFS) was the primary outcome and benefit from IC was evaluated by adjusted hazard ratio. Interaction terms between IC and other prognostic factors were identified in multivariate Cox model, and IC benefit score (ICBS) was calculated based on β coefficients from the Cox model.


RESULTS
Nodal category, overall stage, and pre-treatment plasma Epstein-Barr virus DNA (log transformed as continuous variable) interacted with IC and determined ICBS. ICBS could discriminate patients who benefited differently from IC in terms of DMFS well, especially for patients with high and low ICBS. As for patients with medium ICBS, predictive performance of ICBS seemed reduced.


CONCLUSIONS
Based on the ICBS model, we proposed a decision-making process to help in clinical practice. Multi-institutional and prospective studies are warranted to further validate our findings.
['Peng|Liang|L|', 'Chen|Yu-Pei|YP|', 'Xu|Cheng|C|', 'Tang|Ling-Long|LL|', 'Chen|Lei|L|', 'Lin|Ai-Hua|AH|', 'Liu|Xu|X|', 'Sun|Ying|Y|', 'Ma|Jun|J|']
D000328:Adult D000073888:Cell-Free Nucleic Acids D059248:Chemoradiotherapy D000066491:Clinical Decision-Making D004279:DNA, Viral D018572:Disease-Free Survival D020031:Epstein-Barr Virus Infections D005260:Female D005500:Follow-Up Studies D004854:Herpesvirus 4, Human D006801:Humans D060828:Induction Chemotherapy D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D008954:Models, Biological D000077274:Nasopharyngeal Carcinoma D009303:Nasopharyngeal Neoplasms D009367:Neoplasm Staging D018579:Patient Selection D011379:Prognosis D016016:Proportional Hazards Models D012189:Retrospective Studies
Induction chemotherapy Nasopharyngeal carcinoma Distant metastasis-free survival Benefit prediction model Interaction effect Prognostic index