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Tang W, Long G. Retrospective study of a novel hematological parameter for predicting the survival of patients with nasopharyngeal carcinoma. PeerJ 2024; 12:e17573. [PMID: 38915379 PMCID: PMC11195549 DOI: 10.7717/peerj.17573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Purpose This study aims to explore the prognostic values of routine pre-treatment hematological parameters in patients with nasopharyngeal carcinoma (NPC). Methods The hematological parameters and clinical data of patients with NPC were collected from January 2012 to December 2013 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. The survival statistics were obtained by regularly following-up the patients. The cut-off values for the hematological parameters were calculated using X-tile software. SPSS version 24.0 was used for the statistical analysis. The relationship between the hematological parameters and the prognosis of patients with NPC was analyzed using the Kaplan-Meier method and Cox multivariate regression. The discriminating abilities of the factors, which predict the prognosis, were evaluated by utilizing the receiver operating characteristic (ROC) area under the curve (AUC). Results This study included 179 patients with NPC. Multivariate analysis shows that pretreatment platelet-to-lymphocyte ratio (PLR; hazard ratio; HR = 0.44, 95% CI [0.21-0.91], p = 0.029), serum albumin (ALB; HR = 2.49, 95% CI [1.17-5.30], p = 0.018), and globulin (GLO; HR = 0.44, 95% CI [0.21-0.90], p = 0.024) are independent predictors for 5-year overall survival (OS) in patients with NPC. In addition, pre-treatment PLR (HR = 0.47, 95% CI [0.25-0.90], p = 0.022) and pre-treatment GLO (HR = 0.37, 95% CI [0.19-0.72], p = 0.001) are associated with 5-year progression-free survival (PFS) in patients with NPC. Based on the results of the multivariate analysis, we proposed a new biomarker GLO-PLR, which is observably correlated with the T stage, N stage and clinical stage in patients with NPC. The OS resolving ability of the GLO-PLR evaluated by AUC is 0.714, which is better than those of GLO and PLR. The PFS resolving ability of the GLO-PLR evaluated by AUC was 0.696, which is also better than those of GLO and PLR. Conclusion Pre-treatment PLR, ALB, and GLO are independent predictors of 5-year OS in patients with NPC, where PLR and GLO are also independent predictors of 5-year FPS. Compared with other hematological parameters, the proposed GLO-PLR is an inexpensive, effective, objective, and easy-to-measure marker for predicting the prognosis of NPC.
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Affiliation(s)
- Wenhua Tang
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Army Medical University, Chongqing, Chongqing, China
| | - Guoxian Long
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Yang P, Zhao Y, Liang H, Zhou G, Youssef B, Elhalawani H, Li M, Tan F, Jin Y, Jin H, Zhu H, Mohamed ASR, Chonnipa N, Kannarunimit D, Shi Y, Wang H, Fuller CD. Neutrophil-to-lymphocyte ratio trend: A novel prognostic predictor in patients with nasopharyngeal carcinoma receiving radiotherapy. Int J Biol Markers 2022; 37:270-279. [PMID: 35775111 DOI: 10.1177/03936155221110250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral neutrophil-lymphocyte ratio (NLR), reflecting immune-inflammation status, shows great potential for tumor progression and outcome. Pre-treatment NLR does not fully reflect the immune-inflammatory response to treatment. This study aimed to introduce the NLR trend as a new indicator and to investigate its prognostic value in patients with nasopharyngeal carcinoma receiving radiotherapy. METHODS This retrospective study evaluated patients with nasopharyngeal carcinoma treated with radiotherapy. The NLR trend value was calculated from the fitted line gradient via the NLRs before, during (at least once), and after each patient's first radiotherapy. The Kaplan-Meier curve and log-rank test were used to calculate and compare survival outcomes of different pretreatment NLRs and NLR trends for progression-free survival, locoregional recurrence-free survival (LRFS), and overall survival at 3 and 5 years. Multivariate Cox regression analyses were performed to assess the association between the NLR trend plus 3- and 5-year overall survival. RESULTS The study included 528 patients. A lower NLR trend predicted worse progression-free survival, LRFS, plus 3- and 5-year overall survival. Multivariate Cox regression analysis showed that the NLR trend independently predicted 3- and 5-year overall survival. Sub-group analysis showed that the prognosis of patients with a low pretreatment NLR and a high NLR trend were superior to those of other groups. CONCLUSION The NLR trend independently predicted the prognosis of patients with nasopharyngeal carcinoma receiving radiotherapy. The NLR trend and the pretreatment NLR combination is more precise than pretreatment NLR in predicting prognosis. A high NLR trend may be evidence of a positive immune response to radiotherapy in patients with nasopharyngeal carcinoma.
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Affiliation(s)
- Pei Yang
- Xiangya Hospital, 506618Central South University, Changsha, Hunan, People's Republic of China.,Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Yu Zhao
- Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China.,The Miriam Hospital, Providence, RI, USA
| | - Hao Liang
- Institute of TCM Diagnostics, 118393Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Guanzhi Zhou
- Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China.,University of South China, Hengyang, Hunan, People's Republic of China
| | - Bassem Youssef
- Department of Radiation Oncology, 11238American University of Beirut, Beirut, Lebanon, Lebanon
| | - Hesham Elhalawani
- Department of Radiation Oncology, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Meizhen Li
- Research Institute of Drug Metabolism and Pharmacokinetics, 159374Xiangya School of Pharmaceutical Sciences, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Fengbo Tan
- Xiangya Hospital, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Yi Jin
- Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Hekun Jin
- Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Hong Zhu
- Xiangya Hospital, 506618Central South University, Changsha, Hunan, People's Republic of China
| | | | - Nantavithya Chonnipa
- Department of Medicine, 26683Chulalongkorn University/King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Danita Kannarunimit
- Department of Medicine, 26683Chulalongkorn University/King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingrui Shi
- Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Hui Wang
- Key Laboratory of Translational Radiation Oncology, 117924Hunan Cancer Hospital, the Affiliate Hospital of Xiangya Medical School, 506618Central South University, Changsha, Hunan, People's Republic of China
| | - Clifton David Fuller
- Department of Radiation Oncology, 4002MD Anderson Cancer Center, Houston, TX, USA
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Song S, Chen H, Dou X, Wang K, Yan J, Yu C. The prognostic value of before treatment neutrophil-to-lymphocyte ratio in nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2021; 279:2485-2492. [PMID: 34510259 DOI: 10.1007/s00405-021-07070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this analysis was to evaluate the prognostic significance of inflammatory biomarkers (NLR, dNLR, PLR and LMR) in NPC patients. METHODS This was a retrospective analysis of 111 NPC patients from January 2013 and December 2016. Receiver-operating characteristic (ROC) curve was plotted to determine the cut-off values of these inflammatory biomarkers. Univariate analysis and multivariate Cox regression model were used to evaluate the association between these parameters and progression-free survival (PFS) and overall survival (OS). RESULTS The optimal critical value of NLR was 2.02, by which cases were divided into high NLR group (NLR ≥ 2.02) and low NLR group (NLR < 2.02). The elevated NLR was significantly associated with decreased OS (P = 0.009) and remained significant in multivariate analysis (HR 8.48, 95% CI 1.69-42.46, P = 0.009). CONCLUSIONS The before treatment NLR may be an independent prognostic biomarker for OS in patients with NPC. NLR, dNLR and PLR might be a useful complement to TNM staging in the prognosis evaluation of NPC patients.
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Affiliation(s)
- Shenghua Song
- Department of Otorhinolaryngology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China.,Department of Otorhinolaryngology, Drum Tower Clinical Medical College, Nanjing Medical University, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China.,Research Institute of Otorhinolaryngology, Drum Tower Hospital, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Hong Chen
- Department of Otorhinolaryngology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China.,Department of Otorhinolaryngology, Drum Tower Clinical Medical College, Nanjing Medical University, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China.,Research Institute of Otorhinolaryngology, Drum Tower Hospital, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Xin Dou
- Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Kongcheng Wang
- Department of Oncology, Affiliated Drum Tower Hospital of Nanjing University Medical School, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Jing Yan
- Department of Oncology, Affiliated Drum Tower Hospital of Nanjing University Medical School, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China
| | - Chenjie Yu
- Department of Otorhinolaryngology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China. .,Department of Otorhinolaryngology, Drum Tower Clinical Medical College, Nanjing Medical University, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China. .,Research Institute of Otorhinolaryngology, Drum Tower Hospital, No.321 Zhongshan Road, Nanjing, 210008, People's Republic of China.
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Huang W, Quan T, Zhao Q, Li S, Cai Y, Zhou J, Luo C, Ruan G, Cui C, Liang S, Li H, Liu L. MRI of nasopharyngeal carcinoma: parapharyngeal subspace involvement has prognostic value and influences T-staging in the IMRT era. Eur Radiol 2021; 32:262-271. [PMID: 34327576 DOI: 10.1007/s00330-021-08113-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify the prognosis of parapharyngeal space involvement (PPSI) based on the number of subspaces involved (pre-styloid space, carotid space (CS), areas outside the CS) and explore its significance for current T-staging in patients with nasopharyngeal carcinoma (NPC). METHODS PPSI was retrospectively identified in 1224 patients with non-disseminated NPC at two centers on MRI and separated into four invasion patterns: pattern A (only post-styloid space), pattern B (post-styloid space, CS extension), pattern C (post-styloid space, pre-styloid space extension), and pattern D (all spaces). The Kaplan-Meier analysis and multivariate Cox regression models were used. RESULTS PPSI was diagnosed in 63.4% of cases, with patterns A, B, C, and D in 14.3%, 3.8%, 25.3%, and 18.6% of cases, respectively. No prognostic heterogeneity was observed between pattern B and pattern C (p > 0.05). Thus, the degree of PPSI was based on the number of subspaces involved: grade 0 (none), grade 1 (one), grade 2 (two), and grade 3 (three), which could independently predict overall survival (OS) (p < 0.001). T3 patients with grade 0/1 PPSI (slight-T3) had a better prognosis than those with grade 2/3 PPSI (severe-T3) in terms of OS, locoregional-free survival (LRFS), and progression-free survival (PFS) (all p < 0.001), whose hazard ratios were higher and lower than those with T1 and T2, respectively. Combining the T2 and slight-T3 groups as the proposed T2 provided significant differences in OS, LRFS, and PFS between T2 and T3 (all p < 0.05). CONCLUSIONS The risk of death increased with the number of parapharyngeal subspaces involved. The degree of PPSI is recommended to optimize T3 heterogeneity. KEY POINTS • Parapharyngeal space involvement was proposed to differentiate patient risk groups based on the number of involved subspaces: grade 0 (none), grade 1 (one), grade 2 (two), or grade 3 (three). • The degree of parapharyngeal space involvement was an independent negative prognosticator for OS. • The degree of parapharyngeal space involvement may influence T-staging in patients with nasopharyngeal carcinoma.
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Affiliation(s)
- Wenjie Huang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Tingting Quan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Qin Zhao
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Shuqi Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Yi Cai
- Department of Radiology, Shengli Oilfield Central Hospital, No. 31 Jinan Road, Dongying District, Dongying, Shandong Province, 257034, People's Republic of China
| | - Jian Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Chao Luo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Guangying Ruan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China
| | - Shaobo Liang
- Department of Radiation Oncology, Cancer Center, The First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Guangdong, 528000, Foshan, People's Republic of China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People's Republic of China.
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Chitapanarux I, Lekawanvijit S, Sripan P, Mahanupab P, Chakrabandhu S, Onchan W, Sittitrai P, Boonlert D, Klibngern H, Samuckkeethum W. The prognostic value of excision repair cross-complementing Group 1 expression in nasopharyngeal cancer patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:34. [PMID: 32582340 PMCID: PMC7306241 DOI: 10.4103/jrms.jrms_787_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 11/04/2022]
Abstract
Background Overexpression of excision repair cross-complementing Group 1 (ERCC-1) is related to cisplatin resistance and defective repair of radiation damage. The purpose of this study was to evaluate the clinical significance of excision (ERCC-1) expression in nasopharyngeal cancer (NPC). Materials and Methods We conducted a retrospective review of patients diagnosed with NPC between 2000 and 2013. The archived tissues were analyzed using immunohistochemistry to determine ERCC-1 expression. The ERCC-1 expression level along with other clinical factors and overall survival (OS) were analyzed. Hazard ratio (HR) with a 95% confidence interval was calculated to assess the risk. Results The analysis of ERCC-1 expression was available in 262 NPC patients who had medical records at our hospital. Among those patients, 221 (84%) were treated with curative radiotherapy (RT)/concurrent chemoradiotherapy, 22 (7%) were treated with palliative RT alone, and 19 (9%) were given best supportive care. There was no correlation between ERCC-1 expression and stage of cancer or OS. No difference in 5-year OS was found between patients with low ERCC-1 expression and high ERCC-1 expression (38% vs. 36%; P = 0.981). The adjusted HR (aHR) of cancer death increased with cancer stage (aHR = 2.93 for advanced Stages III-IV; P = 0.001) and age (aHR = 2.11 for age >55; P ≤ 0.001). ERCC-1 expression exhibited no prognostic significance in our study (aHR = 1). Conclusion In this study, ERCC-1 expression has no statistical significance to be considered a prognostic factor for OS among NPC patients. On the other hand, cancer stage, age, and types of treatment can be prognostic factors in NPC patients.
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Affiliation(s)
- Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suree Lekawanvijit
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsak Mahanupab
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wimrak Onchan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichit Sittitrai
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Donyarat Boonlert
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Hanpon Klibngern
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wisarut Samuckkeethum
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Meng L, Wei J, Ji R, Wang B, Xu X, Xin Y, Jiang X. Effect of Early Nutrition Intervention on Advanced Nasopharyngeal Carcinoma Patients Receiving Chemoradiotherapy. J Cancer 2019; 10:3650-3656. [PMID: 31333782 PMCID: PMC6636293 DOI: 10.7150/jca.33475] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. Methods: A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n=46) and late (n=32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or >10% weight loss. The data were collected and statistically analyzed. Results: There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All p<0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All p<0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. Conclusion: Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients' life quality.
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Affiliation(s)
- Lingbin Meng
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
- Department of Internal Medicine, Florida Hospital, Orlando, FL 32804, USA
| | - Jinlong Wei
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
| | - Rui Ji
- Department of Biology, Valencia College, Orlando, FL 32825, USA
| | - Bin Wang
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
| | - Xiaochun Xu
- Department of Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Ying Xin
- The Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun, China
| | - Xin Jiang
- Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China
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Wen X, Yu X, Cheng W, Li Y, Tian J. Quantitative Evaluation of Shear Wave Elastography on Radiation-Induced Neck Fibrosis in Patients With Nasopharyngeal Carcinoma. Ultrasound Q 2019; 37:178-182. [PMID: 31094893 DOI: 10.1097/ruq.0000000000000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
ABSTRACT The value of shear wave elastography (SWE) for quantitatively assessing neck fibrosis induced by radiotherapy (RT) in patients with nasopharyngeal carcinoma was evaluated over time. We prospectively observed 56 patients with nasopharyngeal carcinoma before and after therapeutic neck irradiation. The elasticity parameters including Emax and Emean were used to measure the stiffness of the bilateral sternocleidomastoid muscles. Twenty-seven patients completed a 1.5-year follow-up, with examinations beginning at 3, 6, 12, and 18 months after RT. Forty controls were recruited for reliability tests (along with the patients) and measurement comparisons. The consistency of SWE measurements with the Late Effects Normal Tissue Task Force-Subjective, Objective, Management and Analytic (LENT-SOMA) scale was tested. The intraclass correlation coefficients of elasticity indices for both patients and controls were higher than 0.75. The Emax and Emean of bilateral sternocleidomastoid muscles in the pre-RT patient group were comparable with those of the controls, and increased with increasing postirradiation duration (r = 0.514-0.555; P < 0.01). Significant increases in the Emax and Emean were observed 18 months after RT. The SWE correlated well with the LENT-SOMA score when assessing radiation-induced neck fibrosis 1.5 years after RT (r = 0.557-0.649; P < 0.01). Furthermore, both the Emax and Emean in the LENT-SOMA grade 0 subtype were higher 18 months after RT than before RT (P < 0.01). Because of its high reliability and good consistency with the LENT-SOMA score and better stiffness reflection at grade 0, SWE may be used to objectively and quantitatively evaluate the variation trend of radiation-induced neck fibrosis.
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Affiliation(s)
| | - Xiwen Yu
- Heilongjiang Academy of Medical Sciences
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital
| | - Yang Li
- Department of Radiotherapy Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University
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Tang LL, Liang SB, Huang CL, Zhang F, Xu C, Mao YP, Tian L, Lin AH, Li L, Sun Y, Ma J. The development and external validation of simplified T category classification for nasopharyngeal carcinoma to improve the prognostic value in the intensity-modulated radiotherapy era. Cancer Med 2019; 8:2213-2222. [PMID: 30950240 PMCID: PMC6536995 DOI: 10.1002/cam4.2131] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 11/09/2022] Open
Abstract
Background Intensity‐modulated radiotherapy (IMRT) provides excellent local control in nasopharyngeal carcinoma (NPC). We investigated whether simplifying 8th American Joint Committee on Cancer staging system T categories improves prognostic value. Methods We used 2191 NPC patients as a training set and 414 patients separately as an independent, external validation cohort. Results In the training set, local relapse‐free survival (LRFS), disease‐free survival (DFS), and overall survival (OS) were not significantly different between the 8th edition T2/T3 (P = 0.610, 0.380 and 0.353, respectively). Merging T2 and T3 to proposed T2 (proT2) provided significant differences in LRFS, DFS, and OS between proposed T categories. Proposed T categories had similar c‐indices for LRFS, DFS, and OS (vs the 8th edition), which was validated in the external cohorts. Moreover, for DFS, the adjusted HRs of the proT2N0 (3.8), proT1N1 (3.8), and proT2N1 (6.0) subsets were similar; the adjusted HRs of the proT3N0 (7.0), proT3N1 (11.4), proT1N2 (11.0), proT2N2 (11.6), and proT3N2 (13.3) subsets were similar; the adjusted HRs of the proT1N3 (17.8), proT2N3 (15.3), and proT3N3 (26.4) subsets were similar; the results of the adjusted HRs for OS had the same rule. Defining proT1N0 as stage I; proT1N1/proT2N0‐1 as stage II; proT3N0‐2/proT1‐2N2 as stage III; and proT1‐3N3 as stage IVa generated orderly, significant differences in DFS and OS between stages in the training set and external validation cohort. Conclusions In the IMRT era, three T categories are more reasonable (merging T2/T3 into T2) and proT3N0‐2 (the 8th edition T4N0‐2) should be down‐staged to stage III.
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Affiliation(s)
- Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Shao-Bo Liang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.,Department of Radiation oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan, People's Republic of China
| | - Cheng-Long Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Fan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Cheng Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Li Tian
- Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, SunYat-sen University, Guangzhou, People's Republic of China
| | - Li Li
- Department of Radiation oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
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9
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Jin T, Qin WF, Jiang F, Jin QF, Wei QC, Jia YS, Sun XN, Li WF, Chen XZ. Cisplatin and Fluorouracil Induction Chemotherapy With or Without Docetaxel in Locoregionally Advanced Nasopharyngeal Carcinoma. Transl Oncol 2019; 12:633-639. [PMID: 30797141 PMCID: PMC6383173 DOI: 10.1016/j.tranon.2019.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022] Open
Abstract
In this study, we aim to compare the progression-free survival (PFS) rates and side effects of induction chemotherapy based on docetaxel, cisplatin and fluorouracil (TPF) versus cisplatin and fluorouracil (PF) in patients with locoregionally-advanced nasopharyngeal carcinoma who received subsequent chemoradiotherapy. We randomly assigned 278 patients with stage III or IV NPC (without distant metastases) to receive either TPF or PF induction chemotherapy, followed by cisplatin-based chemoradiotherapy every 3 weeks and intensity-modulated radiation therapy for 5 days per week. After a minimum of 2 years follow-up, a PFS benefit was observed for TPF compared to PF, though this difference was not statistically significant (84.5% vs. 77.9%, P = .380). Due to increased frequencies of grade 3 or 4 neutropenia and diarrhea, significantly more patients in the TPF group required treatment delays and dose modifications. Our findings suggest that PF induction chemotherapy has substantially better tolerance and compliance rates than TPF induction chemotherapy. However, the treatment efficacy of PF is not superior to TPF induction chemotherapy in patients with locoregionally-advanced NPC (ClinicalTrials.gov number, NCT01536223).
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Affiliation(s)
- Ting Jin
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, People's Republic of China; Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China
| | - Wei-Feng Qin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China
| | - Feng Jiang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China
| | - Qi-Feng Jin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China
| | - Qi-Chun Wei
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, People's Republic of China
| | - Yong-Shi Jia
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, People's Republic of China
| | - Xiao-Nan Sun
- Department of Radiation Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, People's Republic of China
| | - Wen-Feng Li
- Department of Chemoradiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Xiao-Zhong Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, People's Republic of China; Key Laboratory of Radiation Oncology in Zhejiang Province, Hangzhou, Zhejiang 310022,People's Republic of China.
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10
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Kim JS, Keam B, Heo DS, Han DH, Rhee CS, Kim JH, Jung KC, Wu HG. The Prognostic Value of Albumin-to-Alkaline Phosphatase Ratio before Radical Radiotherapy in Patients with Non-metastatic Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis. Cancer Res Treat 2019; 51:1313-1323. [PMID: 30699498 PMCID: PMC6790835 DOI: 10.4143/crt.2018.503] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose We first analyzed the prognostic power of albumin-to-alkaline phosphatase ratio (AAPR) before radical radiotherapy (RT) in non-metastatic nasopharyngeal carcinoma (NPC) patients. Materials and Methods The records of 170 patients with biopsy-proven, non-metastatic NPC treated by radical RT between 1998 and 2016 at our institution were retrospectively reviewed. Median follow-up duration was 50.6 months. All patients received intensity-modulated RT and cisplatin based chemotherapy before, during, or after RT. The major treatment of patients was based on concurrent chemoradiotherapy (92.4%). The AAPR was calculated by the last value of both albumin and alkaline phosphatase within 1 month immediately preceding RT. The optimal cut-off level of AAPR was determined by using Cutoff Finder, a web-based system. Propensity score matching (PSM) analysis was performed. Results The optimal cut-off level of AAPR was 0.4876. After PSM analysis of whole cohort, an AAPR was not related to survival outcomes. In PSM analysis for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC), an AAPR ≥ 0.4876 was related to better overall survival (OS), progression-free survival (PFS), and locoregional relapse–free survival (LRRFS) (OS: hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.144 to 0.805; p=0.014; PFS: HR, 0.416; 95% CI, 0.189 to 0.914; p=0.029; and LRRFS: HR, 0.243; 95% CI, 0.077 to 0.769; p=0.016, respectively). Conclusion The AAPR, inexpensive and readily derived from a routine blood test, could be an independent prognostic factor for patients with LA-NPC. And it might help physicians determine treatment plans by identifying the patient's current status. Future prospective clinical trials to validate its prognostic value are needed.
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Seo Rhee
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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11
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He JY, Han P, Zhang Y, Liu YD, Song SJ, Feng GK, An Y, Zhou AJ, Wang HB, Yuan L, Lin ZR, Xia TL, Li MZ, Liu YM, Huang XM, Zhang H, Zhong Q. Overexpression of Nogo receptor 3 (NgR3) correlates with poor prognosis and contributes to the migration of epithelial cells of nasopharyngeal carcinoma patients. J Mol Med (Berl) 2018; 96:265-279. [PMID: 29327067 DOI: 10.1007/s00109-017-1618-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 11/15/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022]
Abstract
Lymph node metastasis (N classification) is one of the most important prognostic factors of nasopharyngeal carcinoma (NPC), and nerve involvement is associated with the transition of the N category in NPC patients. Although the nervous system has been reported to participate in many types of cancer progression, its functions in NPC progression remains unknown. Through analysis of gene profiling data, we demonstrate an enrichment of genes associated with neuronal development and differentiation in NPC tissues and cell lines. Among these genes, Nogo receptor 3 (NgR3), which was originally identified in the nervous system and plays a role in nerve development and regeneration, was inappropriately overexpressed in NPC cells and tissues. Immunohistochemical analysis demonstrated that the overexpression of NgR3 was correlated with poor prognosis in NPC patients. Overexpression of NgR3 promoted, and knocking down NgR3 inhibited, NPC cell migration and invasion in vitro and metastasis in vivo. The ability of NgR3 to promote cell migration was triggered by the downregulation of E-cadherin and enhanced cytoskeletal rearrangement and cell polarity, which were correlated with the activation of focal adhesion kinase (FAK). Collectively, NgR3 is a novel indicator of poor outcomes in NPC patients and plays an important role in driving the progression of NPC. These results suggest a potential link between the nervous system and NPC progression. KEY MESSAGES Genes involved in the neuronal biological process are enriched in nasopharyngeal carcinoma. Overexpression of NgR3 correlates with poor prognosis of nasopharyngeal carcinoma. NgR3 promotes NPC cell migration by downregulating E-cadherin. NgR3 promotes NPC cell polarity and enhances the formation of NPC cell pseudopodia by activating FAK/Src pathway.
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Affiliation(s)
- Jiang-Yi He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.,Institute of Cancer Stem Cell, Dalian Medical University, Dalian, 116000, China
| | - Ping Han
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yong-Dong Liu
- Department of Pathology, the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Shi-Jian Song
- Guangdong Experimental High School, 51 Zhongshan 4th Road, Guangzhou, 510375, China
| | - Guo-Kai Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yu An
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Ai-Jun Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Hong-Bo Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Li Yuan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhi-Rui Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Tian-Liang Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Man-Zhi Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Yan-Min Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xiao-Ming Huang
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Hua Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. .,Institute of Cancer Stem Cell, Dalian Medical University, Dalian, 116000, China.
| | - Qian Zhong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. .,Institute of Cancer Stem Cell, Dalian Medical University, Dalian, 116000, China.
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12
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He SS, Wang Y, Yang L, Chen HY, Liang SB, Lu LX, Chen Y. Plasma Fibrinogen Correlates with Metastasis and is Associated with Prognosis in Human Nasopharyngeal Carcinoma. J Cancer 2017; 8:403-409. [PMID: 28261341 PMCID: PMC5332891 DOI: 10.7150/jca.17028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/29/2016] [Indexed: 01/23/2023] Open
Abstract
Background: The purpose of this observational study was to evaluate the prognostic significance of the pre-treatment plasma fibrinogen level for survival outcomes in nasopharyngeal carcinoma (NPC). Methods: A total of 998 patients with NPC treated at a single centre in China were retrospectively enrolled, of whom 182 (18.2%) developed distant metastasis during follow-up. Survival analyses were performed by the Kaplan-Meier method and Cox regression modelling to measure 3-year overall survival (OS) and distant metastasis-free survival (DMFS). Results: Median OS for the entire cohort was 37.8 months. Using the cut-off value of 3.345 g/L identified in receiver operating curve analysis for fibrinogen, a high pre-treatment plasma fibrinogen level were associated with older age (P = 0.034), advanced TNM stage (P = 0.004) and development of distant metastasis (P < 0.001; Chi-square test). Multivariate Cox proportional hazard analysis demonstrated the pre-treatment plasma fibrinogen level was an independent significant prognostic factor for OS and DMFS in both the entire cohort and also among patients who developed distant metastasis during follow-up. Conclusions: This study suggests the pre-treatment plasma fibrinogen level may serve as an independent prognostic marker to predict the survival outcomes of patients with NPC, including patients with metastatic disease.
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Affiliation(s)
- Sha-Sha He
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China.; State Key Laboratory of Oncology in Southern China, Guangzhou, China.; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan Wang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China.; State Key Laboratory of Oncology in Southern China, Guangzhou, China.; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lin Yang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China.; State Key Laboratory of Oncology in Southern China, Guangzhou, China.; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hai-Yang Chen
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Li-Xia Lu
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China.; State Key Laboratory of Oncology in Southern China, Guangzhou, China.; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yong Chen
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China.; State Key Laboratory of Oncology in Southern China, Guangzhou, China.; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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13
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He S, Wang Y, Peng H, Yang L, Chen H, Liang S, Lu L, Chen Y. Pretreatment Alkaline Phosphatase and Epstein-Barr Virus DNA Predict Poor Prognosis and Response to Salvage Radiotherapy in Patients with Nasopharyngeal Carcinoma and Metachronous Bone-Only Metastasis. J Cancer 2017; 8:417-424. [PMID: 28261343 PMCID: PMC5332893 DOI: 10.7150/jca.17310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/29/2016] [Indexed: 01/25/2023] Open
Abstract
Background: The bones are the most common site of distant metastasis in nasopharyngeal carcinoma (NPC). Few prognostic markers are available to guide treatment and sub-classify patients with bone metastasis. We aimed to identify the prognostic value of pretreatment serum alkaline phosphatase (ALP) and plasma Epstein-Barr virus DNA (EBV DNA) in patients with bone-only metastasis. Methods: A total of 272 patients who developed bone-only metastases after therapy were retrospectively analyzed. Patients were categorized according to pretreatment serum ALP (< or ≥ 110 U/L) and pretreatment plasma EBV DNA (< or ≥ 6,750 copies ml-1). Univariate and multivariate analyses of clinical variables were performed using Cox proportional hazards regression models. Overall survival (OS) was analyzed using the Kaplan-Meier method and compared using the log-rank test. Results: Median OS for the cohort was 34.06 months (range, 2.53-143.87 months). Multivariate Cox proportional hazard analysis verified pretreatment serum ALP and pretreatment plasma EBV DNA were independent prognostic factors for OS. In stratified survival analysis of patients with elevated pretreatment serum ALP and/or plasma EBV DNA, delivery of radiotherapy (RT) to bone metastases provided a significant OS benefit compared to other therapeutic methods (P < 0.05). Conclusions: This study demonstrates two important points: firstly, pretreatment serum ALP and plasma EBV DNA have prognostic value at the first diagnosis of bone-only metastasis in NPC. Secondly, radiotherapy of bone metastasis improves the prognosis of patients with elevated pretreatment serum ALP and plasma EBV DNA.
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Affiliation(s)
- ShaSha He
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China;; State Key Laboratory of Oncology in Southern China, Guangzhou, China;; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yan Wang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China;; State Key Laboratory of Oncology in Southern China, Guangzhou, China;; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hao Peng
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China;; State Key Laboratory of Oncology in Southern China, Guangzhou, China;; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lin Yang
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China;; State Key Laboratory of Oncology in Southern China, Guangzhou, China;; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - HaiYang Chen
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - LiXia Lu
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China;; State Key Laboratory of Oncology in Southern China, Guangzhou, China;; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yong Chen
- Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, China;; State Key Laboratory of Oncology in Southern China, Guangzhou, China;; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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14
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Chen Z, Guo Q, Lu T, Lin S, Zong J, Zhan S, Xu L, Pan J. Pretreatment Serum Lactate Dehydrogenase Level as an Independent Prognostic Factor of Nasopharyngeal Carcinoma in the Intensity-Modulated Radiation Therapy Era. Med Sci Monit 2017; 23:437-445. [PMID: 28120819 PMCID: PMC5289097 DOI: 10.12659/msm.899531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aims of this study were to analyze the prognostic value of baseline lactate dehydrogenase (LDH) among nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT), and to evaluate the potential application of LDH in monitoring treatment efficacy dynamically. Material/Methods From June 2005 to December 2010, 1188 patients with non-metastatic NPC who underwent IMRT with or without chemotherapy were reviewed. Univariate and multivariate analyses were performed to evaluate the predictive value of baseline LDH. Wilcoxon signed-rank test was used to analyze the difference between baseline and post-radiotherapy LDH, and to compare post-radiotherapy LDH with the LDH in cases of distant failure. Results Patients with elevated LDH had significant inferior survival rates, in terms of overall survival (70.0% vs. 83.2%, p=0.010), disease-specific survival (71.1% vs. 85.7%, p=0.002), and distant metastasis-free survival (71.1% vs. 83.4%, p=0.009), but not correlated with locoregional relapse-free survival (p=0.275) or progression-free survival (p=0.104). Subgroup analysis demonstrated that this predictive effect was more significant with advanced stage. Sixty-five post-radiotherapy LDH levels were available from the 90 patients with high LDH at initial diagnosis, and these levels fell in 65 patients, with 62 cases (95.4%) falling within the normal range. Of the 208 patients who experienced distant metastasis, 87 had an available LDH level at that time. Among them, 69 cases (79.3%) had an increased level compared with the post-radiotherapy LDH level. Conclusions Pretreatment LDH is a simple, cost-effective biomarker that could predict survival rates and might be used in individualized treatment. It is also a potential biomarker that might reflect tumor burden and be used to monitor therapy efficacy.
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Affiliation(s)
- Zhuhong Chen
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Qiaojuan Guo
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Tianzhu Lu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Jingfeng Zong
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Shenghua Zhan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Luying Xu
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China (mainland).,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China (mainland).,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China (mainland)
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15
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Tashi S, Purohit BS, Becker M, Mundada P. The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited. Insights Imaging 2016; 7:589-99. [PMID: 27230518 PMCID: PMC4956626 DOI: 10.1007/s13244-016-0498-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/25/2016] [Accepted: 05/03/2016] [Indexed: 01/17/2023] Open
Abstract
Abstract The pterygopalatine fossa (PPF) is a small, clinically inaccessible, fat-filled space located in the deep face that serves as a major neurovascular crossroad between the oral cavity, nasal cavity, nasopharynx, orbit, masticator space, and the middle cranial fossa. Due to its inherent complex location and connections, it can potentially act as a natural conduit for the spread of inflammatory and neoplastic diseases across the various deep spaces in the head and neck. This review aims to acquaint the reader with the imaging anatomy of the PPF, its important communications, and to identify some major pathological conditions that can involve the PPF, especially in conditions where its involvement can have serious diagnostic and therapeutic implications, such as in perineural tumour spread. Teaching points • The PPF is a small neurovascular junction in the deep face with important to-and-fro connections. • Awareness of anatomy of the PPF and its communications helps to simplify imaging of its pathology. • Perineural tumour spread is clinically the most important pathology in this region.
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Affiliation(s)
- Sonam Tashi
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Bela S Purohit
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Minerva Becker
- Department of Imaging, Division of Radiology, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1211, Geneva 14, Switzerland
| | - Pravin Mundada
- Department of Diagnostic Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
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Prognostic value of classifying parapharyngeal extension in nasopharyngeal carcinoma based on magnetic resonance imaging. BIOMED RESEARCH INTERNATIONAL 2015; 2015:749515. [PMID: 25883973 PMCID: PMC4391645 DOI: 10.1155/2015/749515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/29/2014] [Indexed: 11/18/2022]
Abstract
Purpose. To subclassify parapharyngeal extension in nasopharyngeal carcinoma (NPC) and investigate its prognostic value and staging categories based on magnetic resonance imaging (MRI). Methods and Materials. Data from 1504 consecutive NPC patients treated with definitive-intent radiotherapy were analyzed retrospectively. Sites of parapharyngeal extension were defined by MRI. Overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were calculated by the Kaplan-Meier method and compared with the log-rank test. Hazard consistency and hazard discrimination were determined by multivariate analysis with Cox proportional hazards models. Results. 1104 patients (73.4%) had parapharyngeal extension; 1.7–63.8% had involvement of various anatomic sites. The hazard ratio for death was significantly higher with extensive parapharyngeal extension (lateral pterygoid muscle of masticator space and beyond or parotid space) than with mild extension (medial pterygoid muscle of masticator space, or carotid, prestyloid, and prevertebral or retropharyngeal space). OS, LRFS, and DMFS with extensive parapharyngeal extension were similar to those in T4 disease; OS, LRFS, and DMFS with mild parapharyngeal extension were significantly higher than in those T3 disease (all P ≤ 0.015). Conclusions. Parapharyngeal extension in NPC should be subclassified as mild or extensive, which should be regarded as stages T2 and T4 diseases, respectively.
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Han P, Lin ZR, Xu LH, Zhong Q, Zhu XF, Liang FY, Cai Q, Huang XM, Zeng MS. Ribonucleotide reductase M2 subunit expression and prognostic value in nasopharyngeal carcinoma. Mol Med Rep 2015; 12:401-9. [PMID: 25695839 DOI: 10.3892/mmr.2015.3360] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 12/17/2014] [Indexed: 11/06/2022] Open
Abstract
The ribonucleotide reductase M2 subunit (RRM2) modulates the enzymatic activity of ribonucleotide reductase, and is involved in tumor progression. Recently, high levels of RRM2 expression were reported to correlate with poor survival outcomes in patients with colorectal and bladder cancer. However, changes in RRM2 expression in nasopharyngeal carcinoma (NPC), and its effect on the prognosis of this disease remain unknown. The aim of the present study was to analyze the expression of RRM2 in NPC cell lines, and to identify whether RRM2 may serve as a biomarker with which to assess the prognosis of NPC. The present study found that RRM2 expression was higher in NPC cell lines and tissue samples than in noncancerous nasopharyngeal epithelial cell lines and noncancerous tissues, as shown by reverse transcription-quantitative polymerase chain reaction analysis, western blotting and immunohistochemistry staining. Kaplan-Meier survival analysis demonstrated that patients with higher RRM2 expression levels had poorer disease-free survival outcomes than those with lower expression levels of RRM2. Univariate analysis showed that a lower survival rate was significantly associated with high RRM2 expression levels [hazard ratio (HR), 6.424; 95% confidence interval (CI), 2.381-17.333; P<0.001]. Multivariate analysis indicated that RRM2 expression is an independent prognostic factor for patients with NPC (HR, 3.461; 95 % CI, 1.204-9.949; P=0.021). Overexpression of RRM2 led to increased cell proliferation, colony formation, migration and invasion in vivo. These results suggest that high levels of RRM2 expression may be a useful predictor for survival in patients with NPC and may serve as a novel prognostic indicator for these individuals.
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Affiliation(s)
- Ping Han
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Zhi-Rui Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Li-Hua Xu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Qian Zhong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
| | - Xiao-Fen Zhu
- Department of Otolaryngology-Head and Neck Surgery, Huizhou First Hospital, Huizhou, Guangdong 516000, P.R. China
| | - Fa-Ya Liang
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Qian Cai
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Xiao-Ming Huang
- Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Mu-Sheng Zeng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, P.R. China
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Zheng Y, Han F, Xiao W, Xiang Y, Lu L, Deng X, Cui N, Zhao C. Analysis of late toxicity in nasopharyngeal carcinoma patients treated with intensity modulated radiation therapy. Radiat Oncol 2015; 10:17. [PMID: 25582731 PMCID: PMC4302701 DOI: 10.1186/s13014-014-0326-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/30/2014] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To observe the late toxicities in nasopharyngeal carcinoma (NPC) patients who achieved long-term survival after intensity modulated radiation therapy (IMRT). METHODS 208 untreated NPC patients who received IMRT and survived more than five years with locoregional disease control and no metastasis were evaluated in this study. The prescription dose to the gross target volume of nasopharynx (GTVnx), positive neck lymph nodes (GTVnd), clinical target volume 1 (CTV1) and 2 (CTV2) was 68Gy/30f, 60-66Gy/30f, 60 Gy/30f and 54Gy/30f, respectively. The nasopharynx and upper neck targets were irradiated using IMRT, and the lower neck and supraclavicular fossae targets were irradiated using the half-beam technique with conventional irradiation. The late toxicities were evaluated according to the LENT/SOMA criteria of 1995. RESULTS The median follow-up time was 78 months (60-96 months). The occurrence rates of cervical subcutaneous fibrosis, hearing loss, skin dystrophy, xerostomia, trismus, temporal lobe injury, cranial nerve damage, cataract, and brain stem injury induced by radiotherapy were 89.9%, 67.8%, 47.6%, 40.9%, 7.21%, 4.33%, 2.88%, 1.44%, and 0.48%, respectively. No spinal cord injury and mandible damage were found. Grade 3-4 late injuries were observed as follows: 1 (0.48%) skin dystrophy, 4 (1.92%) cervical subcutaneous fibrosis, 2 (0.96%) hearing loss, 2 (0.96%) cranial nerve palsy, and 1 (0.48%) temporal lobe necrosis. No grade 3-4 late injuries occurred in parotid, temporomandibular joints and eyes. Xerostomia decreased gradually over time and then showed only slight changes after 4 years. The change in the incisor distance stabilised by 1 year after RT, however, the incidence of hearing loss, skin dystrophy, subcutaneous fibrosis and nervous system injuries increased over time after RT. CONCLUSION The late injuries in most NPC patients who had long-term survivals after IMRT are alleviated. Within the 5 years of follow-up, we found xerostomia decreased gradually; The change in the incisor distance stabilised by 1 year after RT; while hearing loss, nervous system injuries increased over time after RT.
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Affiliation(s)
- YingJie Zheng
- Department of Radiotherapy, Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Beijing, 100020, PR China.
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
| | - WeiWei Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
| | - YanQun Xiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
| | - LiXia Lu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
| | - XiaoWu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
| | - NianJi Cui
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
| | - Chong Zhao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, PR China.
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Xie Y, Wei ZB, Duan XW. Prognostic value of pretreatment serum alkaline phosphatase in nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2015; 15:3547-53. [PMID: 24870755 DOI: 10.7314/apjcp.2014.15.8.3547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognostic value of serum alkaline phosphatase (S-ALP) has not been fully validated for nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS S-ALP levels were measured in 601 patients newly diagnosed with NPC before radical treatment, and possible associations of these levels with 5-year overall survival (OS) and tumor-free survival (TFS) were explored using univariate and multivariate analyses. RESULTS Elevated pretreatment S-ALP (>85 U/L) was significantly less frequent among patients classified as T1+2 or stage I+II than among those classified as T3+4 or stage III+IV. Multivariate analysis showed that elevated pretreatment S-ALP (>85 U/L), age, T classification and N stage were independent predictors of poor OS and TFS. CONCLUSIONS Pretreatment S-ALP may be a reliable biomarker to evaluate the long-term prognosis of patients with NPC.
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Affiliation(s)
- Ying Xie
- Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University China E-mail :
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A comparison between the sixth and seventh editions of the UICC/AJCC staging system for nasopharyngeal carcinoma in a Chinese cohort. PLoS One 2014; 9:e116261. [PMID: 25536307 PMCID: PMC4275293 DOI: 10.1371/journal.pone.0116261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/04/2014] [Indexed: 11/21/2022] Open
Abstract
Background The International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) TNM staging system of nasopharyngeal carcinoma (NPC) is the most important system for survival prediction. The TNM 7th edition UICC/AJCC TNM staging system for NPC was adopted in January 2009, and is now internationally recommended. In comparison with the TNM 6th edition, there were several revisions in the new edition staging system. This study aims to evaluate the prognostic value of the TNM 7th edition for NPC patients in comparison with the TNM 6th edition. Method Clinical data of 2,629 NPC patients from the Sun Yat-sen University Cancer Center between January 2006 and December 2010 were retrospectively collected and all the patients were restaged according to the criteria of the TNM 6th edition and TNM 7th edition UICC/AJCC staging manual. Univariate and multivariate COX proportional hazards analyses were applied to evaluate the prognostic values between adjacent stage categories of the TNM 6th edition and TNM 7th edition. Results In comparison with the TNM 6th edition, a significant alteration of the distribution of N categories was observed when the TNM 7th edition was applied (χ2 = 20.589, P<0.001), with 119 (119/670, 17.8%) patients up-staging from N0 to N1. With regard to T and overall stage, 37 (37/561, 6.6%) patients were down-staged from T2a with the TNM 6th edition to T1 with the TNM 7th edition, and finally two patients were up-staged to overall stage II (2/118, 1.7%). Moreover, the survival curves were significantly segregated (P<0.05) between T1 and T2 as well as N1 and N2 with the TNM 7th edition. Conclusions The TNM 7th edition led to a significant alteration in the distribution of N categories and it is superior to the TNM 6th edition in predicting the frequency of overall survival and distant metastasis-free survival.
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Wang W, Feng M, Fan Z, Li J, Lang J. Clinical outcomes and prognostic factors of 695 nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:814948. [PMID: 25162028 PMCID: PMC4139082 DOI: 10.1155/2014/814948] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/02/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated. METHODS Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67-76 Gy in 30-33 fractions, positive neck lymph nodes (GTVln-R/L) 60-70 Gy in 30-33 fractions, high-risk clinical target volume (CTV1) 60-66 Gy, low-risk clinical target volume (CTV2) 54-60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50-55 Gy. RESULTS The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively. CONCLUSION The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.
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Affiliation(s)
- Weidong Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital, Renmin South Road 4th Section, No. 55, Chengdu 610041, China
| | - Mei Feng
- Department of Radiation Oncology, Sichuan Cancer Hospital, Renmin South Road 4th Section, No. 55, Chengdu 610041, China
| | - Zixuan Fan
- Department of Radiation Oncology, Sichuan Cancer Hospital, Renmin South Road 4th Section, No. 55, Chengdu 610041, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital, Renmin South Road 4th Section, No. 55, Chengdu 610041, China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital, Renmin South Road 4th Section, No. 55, Chengdu 610041, China
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Wei Z, Zeng X, Xu J, Duan X, Xie Y. Prognostic value of pretreatment serum levels of lactate dehydrogenase in nonmetastatic nasopharyngeal carcinoma: single-site analysis of 601 patients in a highly endemic area. Onco Targets Ther 2014; 7:739-49. [PMID: 24868167 PMCID: PMC4031205 DOI: 10.2147/ott.s59804] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Numerous studies have generated promising but incomplete evidence for the prognostic value of pretreatment serum levels of lactate dehydrogenase (S-LDH) in nasopharyngeal carcinoma (NPC). Methods Pretreatment serum levels of S-LDH in 601 patients with NPC were measured before treatment, and their associations with overall survival and tumor-free survival were studied. Univariate and multivariate analysis of subgroups was used to evaluate the prognostic value of S-LDH in early-stage and late-stage NPC separately. Results Pretreatment S-LDH levels were significantly lower in T1+2 patients than in T3+4 patients, lower in N0+1 patients than in N2+3 ones, and lower in stage I + II patients than in III + IV ones. Multivariate analysis showed that among patients with late-stage NPC, high pretreatment S-LDH levels >225 U/L were an independent predictor of poor overall survival and tumor-free survival. Among patients with early-stage NPC, pretreatment S-LDH levels >171 U/L, which overlap with the normal range, were an independent predictor of shorter overall survival and tumor-free survival. Conclusion Pretreatment S-LDH levels may be a reliable biomarker for predicting the long-term prognosis of patients with early-stage or late-stage NPC.
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Affiliation(s)
- Zhengbo Wei
- Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xianjie Zeng
- Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jian Xu
- Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Xuwei Duan
- Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Ying Xie
- Guangxi Key Laboratory for High-Incidence Tumor Prevention and Treatment, Experimental Center of Medical Science of Guangxi Medical University, Nanning, People's Republic of China
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Kong F, Ying H, Huang S, Du C, Zhou J, Hu C. Preliminary results of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: a retrospective study of 364 patients. Eur Arch Otorhinolaryngol 2014; 271:3283-90. [PMID: 24534894 DOI: 10.1007/s00405-014-2900-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
The aim of the study was to evaluate the survival and toxicity of 364 patients with nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT). Cisplatin-based chemotherapy was given to patients with local-regionally advanced disease. The median follow-up was 26 months (range 3-62 months). The 2-year local failure-free survival, regional failure-free survival (RFFS), distant metastasis-free survival (DMFS) and overall survival (OS) were 97.6, 96.8, 89.1 and 93.5 %, respectively. Overall disease failures (at any site) were found in 60 patients. Eighteen patients experienced locoregional failures: seven were local only, seven were regional only and four were both local and regional. Forty-two patients developed distant metastases. Of these, 30 patients had single organ metastasis and 12 had multiple organ metastases. The most common acute toxicities were dermatitis, mucositis and xerostomia. Grade 0-2 dermatitis, mucositis and xerostomia occurred in 337 patients (92.6 %), 204 patients (56.1 %) and 364 patients (100 %), respectively. Grade 3 dermatitis, mucositis and xerostomia were seen in 27 patients (7.4 %), 160 patients (44 %) and 0 patients. No Grade 4 acute toxicities were observed. N stage was an independent prognostic factor for RFFS, DMFS and OS. Our preliminary results showed that IMRT provides excellent local-regional control for NPC, with acceptable acute toxicities. Distant metastasis remains the most difficult treatment challenge. More effective systemic chemotherapy should be explored.
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Affiliation(s)
- Fangfang Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
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Yang J, Li L, Ren Y, Li X, Tu Y, Ma J, Sun R, Zhao L. Clinical significance of joint detection of CD44v6 and CD62P in nasopharyngeal carcinoma. ACTA ACUST UNITED AC 2013; 36:629-34. [PMID: 24192766 DOI: 10.1159/000356041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to investigate the expression and clinical prognostic significance of adhesion molecules in nasopharyngeal carcinoma (NPC) tissues and peripheral blood. MATERIALS AND METHODS Flow cytometry assays for the expression levels of CD44v6 and CD62P protein in peripheral blood and tissues from controls and NPC patients were performed. Clinical and pathological features were reported and analyzed, and a survival study was carried out. RESULTS The expression of CD44v6 and CD62P in NPC tissues and peripheral blood was higher than that of the control group (p < 0.05). Expression levels in peripheral blood of stage III/IV NPC patients was markedly higher than that of patients in stage I/II (p < 0.05), while it had no statistically significant difference in tissues (p > 0.05). The expression levels of CD44v6 and CD62P in the lymph gland metastasis and distant metastasis group were higher than groups without such metastasis (p < 0.05), and there was no statistical difference in NPC tissues (p > 0.05). The survival rates of NPC groups with low expression in the peripheral blood were higher than those of high-expression groups (p < 0.05). CONCLUSION Joint detection of CD44v6 and CD62P in the peripheral blood or tissues of NPC patients has diagnostic and prognostic value as a marker of poor clinical outcome.
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Wei Z, Zeng X, Xu J, Duan X, Yang J, Xie Y. Prognostic value of the pretreatment serum level of cytokeratin fraction 21-1 in undifferentiated nasopharyngeal carcinoma: a study of 332 cases. Head Neck 2013; 36:71-6. [PMID: 23728904 DOI: 10.1002/hed.23261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Prognostic value of serum cytokeratin fraction 21-1 (CYFRA 21-1) has not been fully validated for nasopharyngeal carcinoma (NPC). METHODS Serum CYFRA 21-1 levels of 332 patients with NPC were measured before treatment, and their association with overall survival (OS), tumor-free survival (TFS), time to local recurrence (TLR), and time to distant recurrence (TDR) was studied. RESULTS Pretreatment serum CYFRA 21-1 level of patients with classification of T1+2 , N0 , stage I+II was significantly lower than that of those with T3+4 , N1+2+3 and III+IV, respectively. Multivariate analysis showed that a high pretreatment serum level of CYFRA 21-1 and T classification were independent predictors of poor OS and TDR. A high pretreatment level of CYFRA 21-1 was an independent predictor of shorter TFS and TLR. CONCLUSION The pretreatment serum level of CYFRA 21-1 would be a reliable biomarker to evaluate the long-term prognosis of patients with undifferentiated NPC.
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Affiliation(s)
- Zhengbo Wei
- Department of Head and Neck Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
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Zhang L, Chen QY, Liu H, Tang LQ, Mai HQ. Emerging treatment options for nasopharyngeal carcinoma. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:37-52. [PMID: 23403548 PMCID: PMC3565571 DOI: 10.2147/dddt.s30753] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Nasopharyngeal carcinoma is endemic in Asia and is etiologically associated with Epstein–Barr virus. Radiotherapy is the primary treatment modality. The role of systemic therapy has become more prominent. Based on multiple phase III studies and meta-analyses, concurrent cisplatin-based chemoradiotherapy is the current standard of care for locally advanced disease (American Joint Committee on Cancer manual [7th edition] stages II–IVb). The reported failure-free survival rates from phase II trials are encouraging for induction + concurrent chemoradiotherapy. Data from ongoing phase III trials comparing induction + concurrent chemoradiotherapy with concurrent chemoradiotherapy will validate the results of these phase II studies. Intensity-modulated radiotherapy techniques are recommended if the resources are available. Locoregional control exceeding 90% and reduced xerostomia-related toxicities can now be achieved using intensity-modulated radiotherapy, although distant control remains the most pressing research problem. The promising results of targeted therapy and Epstein–Barr virus-specific immunotherapy from early clinical trials should be validated in phase III clinical trials. New technology, more effective and less toxic chemotherapy regimens, and targeted therapy offer new opportunities for treating nasopharyngeal carcinoma.
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Affiliation(s)
- Lu Zhang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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Liu N, Cui RX, He QM, Huang BJ, Sun Y, Xie D, Zeng J, Wang HY, Ma J. Reduced expression of Dicer11 is associated with poor prognosis in patients with nasopharyngeal carcinoma. Med Oncol 2013; 30:360. [PMID: 23307239 DOI: 10.1007/s12032-012-0360-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/02/2012] [Indexed: 11/28/2022]
Abstract
Dicer11 plays an important role in generation of microRNA and is dysregulated in a variety of human cancers. The purpose of this study was to evaluate Dicer11 expression and its prognostic value in nasopharyngeal carcinoma (NPC). The protein expression of Dicer1 was examined by immunohistochemistry in 276 NPC specimens, and the mRNA levels of Dicer1 were analyzed by qRT-PCR in 56 NPC and 11 nasopharyngitis tissues. Cox regression analysis was used to identify independent prognostic factors, and a prognostic score model was constructed for survival prediction. Expression of Dicer1 was downregulated in NPC tissues at both the mRNA and the protein levels, and there was a notable positive correlation between the expression levels of Dicer1 mRNA and protein. Low Dicer1 expression was positively correlated with distant metastasis (P < 0.01) and death (P = 0.01). In addition, low expression of Dicer1 was significantly associated with poorer overall survival (HR, 2.32; 95 % CI 1.30-4.14; P < 0.01) and poorer distant metastasis-free survival (HR, 2.56; 95 % CI 1.39-4.74; P < 0.01). Furthermore, multivariate analysis showed that low expression of Dicer1 and tumor-node-metastasis (TNM) stage was independent prognostic indicators for NPC patients. A prognostic score model combining the Dicer1 expression and TNM stage had a better prognostic value than the TNM stage alone model or Dicer1 expression alone model (P < 0.05). Dicer1 was downregulated in NPC tissues at both the mRNA and the protein levels, and low expression of Dicer1 could be served as novel prognostic biomarker for NPC patients.
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Affiliation(s)
- Na Liu
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
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Huang PY, Sun ZY, Xie CM, Chen QY, Wen YF, Li J, Qiu HZ, Liu H, Zhong ZL, Mai HQ, Mo HY. Prognostic significance of the various classifications for parapharyngeal space involvement in nasopharyngeal carcinoma. Acta Otolaryngol 2012; 132:1197-207. [PMID: 22690693 DOI: 10.3109/00016489.2012.691211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Advanced parapharyngeal space (PPS) involvement showed stronger prognostic value than PPS involvement. The classification of PPS involvement proposed by Min or Sham was the most appropriate classification for parapharyngeal extension in nasopharyngeal carcinoma (NPC). The degree of tumor extension into the PPS should be considered in future TNM staging revisions. OBJECTIVES This study was conducted to evaluate the prognostic significance of the various classifications for PPS involvement in patients with NPC. METHODS From January to July 2000, a total of 176 patients with pathologically diagnosed NPC were prospectively enrolled in this study. The extent of PPS involvement was examined by contrast-enhanced computed tomography (CT) scan and graded according to the four previously reported classifications (Min, Sham, Xiao, and Heng). RESULTS The incidence of PPS involvement was 81.8%. The 5-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local relapse-free survival rates (LRFS) of the patients with and without PPS involvement were 68.1% and 90.2% (p = 0.010), 66.1% and 87.2% (p = 0.013), 76.7% and 93.6% (p = 0.032), and 84.9% and 93.1% (p = 0.220), respectively. Multivariate analysis showed that PPS involvement (yes vs no) was not an independent prognostic factor. However, graded PPS involvement was an independent factor affecting the prognosis of NPC. When the four classifications were included in a Cox model, it was shown that PPS involvement based on Min's classification was an independent factor for OS (p = 0.001). PPS involvement based on Sham's classification was an independent factor for PFS (p = 0.010) and DMFS (p = 0.009).
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Affiliation(s)
- Pei-Yu Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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Adjuvant chemotherapy in advanced nasopharyngeal carcinoma based on plasma EBV load. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0036-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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31
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Lee AWM, Ng WT, Chan LK, Chan OSH, Hung WM, Chan CC, Cheng PTC, Sze H, Lam TS, Yau TK. The strength/weakness of the AJCC/UICC staging system (7th edition) for nasopharyngeal cancer and suggestions for future improvement. Oral Oncol 2012; 48:1007-1013. [PMID: 22525607 DOI: 10.1016/j.oraloncology.2012.03.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the current AJCC/UICC staging system (7th edition) for nasopharyngeal carcinoma and to explore for future improvement. MATERIALS AND METHODS A total of 985 patients, initially staged with preceding 5-6th edition, were retrospectively re-staged with the 7th edition. All were assessed by magnetic resonance imaging, and all 945 non-disseminated patients were irradiated with conformal/intensity-modulated technique. RESULTS Staging factors by both the 5-6th edition and the 7th edition were strongly significance for important endpoints (p<0.001). Down-staging of the previous T2a to T1 and, stages IIA to I in the 7th edition was appropriate. However, the impacts on overall stage distribution and prognostication were minimal. Further down-staging of the current T2 to T1, N2 to N1, stages II to I, and merging of N3a and N3b, stages IVA and IVB were suggested. With the 7th edition, the 5-year disease-specific survival (DSS) was 100% for stage I, 95% for II, 90% for III, 67% for IVA, 68% for IVB and 18% for IVC. The corresponding DSS for the proposed stages I, II, III and IV were 95%, 86%, 67% and 18%, respectively. CONCLUSIONS The changes introduced in the 7th edition were appropriate, but the magnitude of improvement was minimal. With improving results by modern management, further simplification of the staging system is suggested. The proposed system could lead to more accurate prognostication, further validation is warranted.
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Affiliation(s)
- Anne W M Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
| | - W T Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - L K Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Oscar S H Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - W M Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - C C Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Peter T C Cheng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Henry Sze
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - T S Lam
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - T K Yau
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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Sun Y, Tang LL, Chen L, Li WF, Mao YP, Liu LZ, Lin AH, Li L, Ma J. Promising treatment outcomes of intensity-modulated radiation therapy for nasopharyngeal carcinoma patients with N0 disease according to the seventh edition of the AJCC staging system. BMC Cancer 2012; 12:68. [PMID: 22336097 PMCID: PMC3332280 DOI: 10.1186/1471-2407-12-68] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 02/15/2012] [Indexed: 12/03/2022] Open
Abstract
Background Intensity-modulated radiation therapy (IMRT) provides excellent locoregional control for nasopharyngeal carcinoma (NPC), and has gradually replaced two-dimensional conventional radiotherapy as the first-line radiotherapy technique. Furthermore, in the new seventh edition of the American Joint Committee on Cancer (AJCC) staging system, retropharyngeal lymph nodes were upgraded from N0 to N1 disease as a result of their negative impact on the distant metastasis-free survival (DMFS) rates of NPC. This retrospective study was conducted in order to review the treatment outcomes and patterns of failure in NPC patients with N0 disease after IMRT in order to effectively guide treatment in the future. Methods We retrospectively reviewed data from 506 biopsy-proven nonmetastatic NPC patients. There were 191 patients with negative cervical lymph node involvement. According to the seventh edition of the American Joint Committee on Cancer (AJCC) staging system, 110 patients (21.7%) were staged with N0 disease, and 81 patients (16.0%) were reclassified with N1 disease due to the presence of RLN metastasis. All patients received IMRT as the primary treatment. Results In patients with negative cervical lymph node involvement, distant metastasis-free survival (DMFS) was significantly higher in patients without retropharyngeal lymph node (RLN) metastasis than those with RLN metastasis (95.9% vs. 88.1% respectively, P = 0.04). For N0 disease, the 5-year overall survival (OS), local relapse-free survival (LRFS), nodal relapse-free survival (NRFS) and DMFS rates were 93.8%, 97.1%, 99.1% and 95.9%, respectively. For T1N0, T2N0, T3N0 and T4N0, OS was 97.8%, 100%, 93.8% and 76.9%, LRFS was 100%, 92.9%, 100% and 88.9% and DMFS was 96.6%, 90.9%, 100% and 93.3%, respectively. OS and LRFS were higher in T1-3 N0 patients than T4N0 patients (P < 0.01 and P = 0.01, respectively). Conclusions The seventh edition of the AJCC N-staging system improves prognostic accuracy by upgrading RLN metastasis to N1 disease. IMRT produces excellent survival rates in T1-3 N0 disease; however, T4N0 disease remains a challenge and additional improvements are required to achieve a favorable prognosis for these NPC patients.
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Affiliation(s)
- Ying Sun
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, No,651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
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Ong YK, Solares CA, Lee S, Snyderman CH, Fernandez-Miranda J, Gardner PA. Endoscopic nasopharyngectomy and its role in managing locally recurrent nasopharyngeal carcinoma. Otolaryngol Clin North Am 2012; 44:1141-54. [PMID: 21978898 DOI: 10.1016/j.otc.2011.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Local recurrence after primary radiation of nasopharyngeal carcinoma (NPC) remains an important cause of morbidity and mortality. Salvage treatment using reirradiation or surgery has been shown to improve survival over nontreatment. Surgery is traditionally performed using an open approach. Advances in endoscopic approaches for resection of paranasal sinus tumors have been extended to NPC. This article reviews the treatment options, in particular the role of endoscopic nasopharyngectomy in the management of recurrent NPC. The endoscopic anatomy, surgical principles, and published results on endoscopic nasopharyngectomy are presented. Short-term outcomes for early-stage recurrences are promising but long-term follow-up is needed.
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Affiliation(s)
- Yew Kwang Ong
- Department of Otolaryngology-Head & Neck Surgery, National University Hospital, 1E Kent Ridge Road, Singapore 119228.
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Abstract
Malignant tumours with nasopharyngeal primary location are relatively rare in children. One of the most frequent paediatric neoplasms in this region is the undifferentiated nasopharyngeal carcinoma tumour (UCNT). These tumours are usually revealed by nasal obstruction, headache or cervical nodal involvement. The nasopharyngeal mass can be discovered during an ear-nose and throat examination and confirmed after medical imaging investigation. Diagnostic is obtained by nasopharyngeal mass or cervical nodal biopsy. This tumor has a high chemo and radio-sensibility in children. Irradiation of the cavum and the nodes areas remains as the reference treatment of this disease. Most paediatric protocols add chemotherapy to radiotherapy. The value of concomitant or adjuvant chemotherapy is still debated in paediatric population. It was shown that the T and N staging at diagnosis determined by the classification TNM is a major prognostic factor. Due to the importance of the loco-regional sequelae after irradiation and the satisfactory global prognosis, the actual trend is a decrease in the total dose of irradiation delivered, particularly for patient with a good response to first chemotherapy. This article sheds light on the particularities of UCNT in paediatric patients.
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Hua Y, Ma S, Fu Z, Hu Q, Wang L, Piao Y. Intracavity hyperthermia in nasopharyngeal cancer: A phase III clinical study. Int J Hyperthermia 2011; 27:180-6. [DOI: 10.3109/02656736.2010.503982] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hu YC, Chang CH, Chen CH, Ger LP, Liu WS, Lin LC, Leung CM, Chang KC. Impact of intracranial extension on survival in stage IV nasopharyngeal carcinoma: identification of a subset of patients with better prognosis. Jpn J Clin Oncol 2010; 41:95-102. [PMID: 20852300 DOI: 10.1093/jjco/hyq171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE T-stage is an imperfect prognostic indicator for patients with nasopharyngeal carcinoma. We evaluated the effect of extent of intracranial involvement on survival after conventional radiotherapy in patients with Stage T4 nasopharyngeal carcinoma. METHODS We conducted a retrospective analysis of the results of computed tomography, magnetic resonance imaging and treatment outcomes in 84 consecutive patients with Stage T4 nasopharyngeal carcinoma during the period September 1993 to December 2002 in Taiwan. The patients were subcategorized into those who had limited intracranial involvement (primary nasopharyngeal tumors with involvement of the unilateral cavernous sinus or the parasellar region only) or extensive involvement (extension of the tumors to the bilateral cavernous sinus or the parasellar region, into the orbit and the ethmoid sinus anteriorly, or to the prepontine region and the posterior cranial fossa). RESULTS Extensive intracranial involvement was found in 51.2% of the patients. Among these patients, the 5-year rate of overall survival after conventional radiotherapy was only 3.4%. In contrast, the 5-year survival among patients with limited intracranial involvement was 42.9%. This difference was significant (P < 0.001). In the multivariate analysis, extensive intracranial involvement, advanced age and a nodal status of N3 correlated with poor overall survival (all P < 0.05). CONCLUSIONS Among patients with T4 nasopharyngeal carcinoma, better treatment outcomes were associated with limited intracranial involvement. We conclude that a subdivision of Stage T4 nasopharyngeal carcinoma disease based on the extent of intracranial involvement would provide better prognostic information.
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Affiliation(s)
- Yu-Chang Hu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Intensity-modulated radiation therapy without concurrent chemotherapy for stage IIb nasopharyngeal cancer. Am J Clin Oncol 2010; 33:294-9. [PMID: 20395788 DOI: 10.1097/coc.0b013e3181d2edab] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the treatment outcome of patients with stage IIB nasopharyngeal carcinoma (NPC) after definitive intensity-modulated radiotherapy (IMRT) without concurrent chemotherapy. METHODS Between August 2003 and December 2006, 107 patients with T1N1M0 (8%), T2N0M0 (13%), or T2N1M0 (79%) NPC were definitively treated with IMRT. Sixty-one received IMRT only, and 46 patients had various strategies of systemic treatment, consisting of abbreviated neoadjuvant (38 patients), concurrent (8 patients), or adjuvant (16 patients) chemotherapy. Radiation doses prescribed to the planning tumor volume of the gross disease, high-risk clinical tumor volume, and low-risk clinical tumor volume were 66 to 70 Gy, 54 to 60 Gy, and 50-54 Gy, respectively. RESULTS With a median follow-up of 39 months (range, 7-77 months), 6 patients had locoregional relapse: 1 local only, 1 locoregional, and 4 regional only. Five patients had distant failure. Five of 6 total deaths were cancer related. The 3-year estimated local control, regional control, metastasis-free survival, disease-free survival, and overall survival were 96.5%, 98%, 94.8%, 90.7%, and 95.8%, respectively. No significant difference in treatment outcome was demonstrated in patients treated with or without chemotherapy of any schedule. CONCLUSIONS IMRT without concurrent chemotherapy provides good outcome for patients with stage IIB NPC with acceptable toxicity. Neoadjuvant chemotherapy did not appear to provide significant additional benefit for this patient subgroup. Further investigation in the prospective setting is warranted to explore the role of systemic agents in the treatment of NPC with limited primary disease and cervical lymphadenopathy when IMRT is used.
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Abstract
Nasopharyngeal carcinomas (NPC) are predominantly of undifferentiated type (UCNT or undifferentiated carcinoma of nasopharyngeal type), rare (<1/100,000) and sporadic in occidental countries, but endemic in the Mediterranean area of intermediate incidence (2 to 10/100,000) and highly frequent (>10/100,000) in South East Asia. NPC staging is based on TNM UICC 2002 that has a prognostic and therapeutic orientation impact. Irradiation of the primitive tumor and its extensions remains the standard loco-regional treatment. The recent introduction of primary and concomitant chemotherapy leads to an improvement in terms of overall and disease-free survival, specially for for high-risk-patients (T3-4 and N2-3 disease). Prognosis remain linked to T, N, histologic type and quality of response to chemotherapy and radiotherapy.
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Adams WM, Kleiter MM, Thrall DE, Klauer JM, Forrest LJ, La Due TA, Havighurst TC. Prognostic significance of tumor histology and computed tomographic staging for radiation treatment response of canine nasal tumors. Vet Radiol Ultrasound 2009; 50:330-5. [PMID: 19507402 DOI: 10.1111/j.1740-8261.2009.01545.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prognostic significance of tumor histology and four computed tomography (CT) staging methods was tested retrospectively in dogs from three treatment centers that underwent intent-to-cure-radiotherapy for intranasal neoplasia. Disease-free and overall survival times were available for 94 dogs. A grouping of anaplastic, squamous cell, and undifferentiated carcinomas had a significantly shorter median disease-free survival (4.4 mo) than a grouping of all sarcomas (10.6 months). Disease-free survivals were not significantly different, when all carcinomas were compared with all sarcomas. The published original and modified WHO staging methods did not significantly relate to either survival endpoint. A modified human maxillary tumor staging system previously applied to canine nasal tumors was prognostically significant for both survival endpoints; a further modified version of that CT-based staging system resulted in improved significance for both survival endpoints. Dogs with unilateral intranasal involvement without bone destruction beyond the turbinates on CT, had longest median survival (23.4 months); CT evidence of cribriform plate involvement was associated with shortest median survival (6.7 months). Combining CT and histology statistically improved prognostic significance for both survival endpoints over the proposed CT staging method alone. Significance was lost when CT stages were collapsed to < four categories or histopathology groupings were collapsed to < three categories.
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Affiliation(s)
- William M Adams
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.
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Comparison of single versus fractionated dose of stereotactic radiotherapy for salvaging local failures of nasopharyngeal carcinoma: a matched-cohort analysis. HEAD & NECK ONCOLOGY 2009; 1:13. [PMID: 19463191 PMCID: PMC2694191 DOI: 10.1186/1758-3284-1-13] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 05/23/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Local failure is an important cause of morbidity and mortality in nasopharyngeal carcinoma (NPC). Although surgery or brachytherapy may be feasible in selected cases, most patients with local failure require external beam re-irradiation. Stereotactic radiation using single or multiple fractions have been employed in re-irradiation of NPC, but the optimal fractionation scheme and dose are not clear. METHODS Records of 125 NPC patients who received salvage stereotactic radiation were reviewed. A matched-pair design was used to select patients with similar prognostic factors who received stereotactic re-irradiation using single fraction (SRS) or multiple fractions (SRM). Eighty-six patients were selected with equal number in SRS and SRM groups. All patients were individually matched for failure type (persistent or recurrent), rT stage (rT1-2 or rT3-4), and tumor volume (< or = 5 cc, >5-10 cc, or >10 cc). Median dose was 12.5 Gy in single fraction by SRS, and 34 Gy in 2-6 fractions by SRM. RESULTS Local control rate was better in SRM group although overall survival rates were similar. One- and 3-year local failure-free rates were 70% and 51% in SRS group compared with 91% and 83% in SRM group (p = 0.003). One- and 3-year overall survival rates were 98% and 66% in SRS group compared with 78% and 61% in SRM group (p = 0.31). The differences in local control were mainly observed in recurrent or rT2-4 disease. Incidence of severe late complications was 33% in SRS group vs. 21% in SRM group, including brain necrosis (16% vs. 12%) and hemorrhage (5% vs. 2%). CONCLUSION Our study showed that SRM was superior to SRS in salvaging local failures of NPC, especially in the treatment of recurrent and rT2-4 disease. In patient with local failure of NPC suitable for stereotactic re-irradiation, use of fractionated treatment is preferred.
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Re-Evaluation of 6th Edition of AJCC Staging System for Nasopharyngeal Carcinoma and Proposed Improvement Based on Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys 2009; 73:1326-34. [DOI: 10.1016/j.ijrobp.2008.07.062] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 06/30/2008] [Accepted: 07/10/2008] [Indexed: 11/22/2022]
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Pan JJ, Zhang SW, Chen CB, Xiao SW, Sun Y, Liu CQ, Su X, Li DM, Xu G, Xu B, Lu YY. Effect of recombinant adenovirus-p53 combined with radiotherapy on long-term prognosis of advanced nasopharyngeal carcinoma. J Clin Oncol 2008; 27:799-804. [PMID: 19103729 DOI: 10.1200/jco.2008.18.9670] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To centrally assess the safety, efficacy, and 6-year follow-up of recombinant adenovirus-p53 (rAd-p53) combined with radiotherapy (RT) for patients with nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS A randomized controlled clinical study on rAd-p53 combined with RT in 42 patients with NPC was compared with a control group of 40 patients with NPC treated with RT alone. In the group receiving rAd-p53 combined with RT, rAd-p53 was intratumorally injected once a week for 8 weeks. Concurrent RT (70 Gy in 35 fractions) was given to the nasopharyngeal tumor and neck lymph node. Patients and tumors were monitored for adverse events and responses. RESULTS rAd-p53-specific p53 mRNA was detected in postinjection of rAd-p53 biopsies from 16 (94.1%) of 17 patients. Upregulation of p21/WAF1 and Bax and downregulation of vascular endothelial growth factor were observed in postinjection tumor biopsy. Complete response rate in the group receiving rAd-p53 combined with RT was observed at 2.73 times that of the group receiving RT alone (66.7% v 24.4%). Six-year follow-up data showed that rAd-p53 significantly increased the 5-year locoregional tumor control rate by 25.3% for patients with NPC treated with irradiation (P = .002). The 5-year overall survival rate and 5-year disease-free survival rate of the group receiving rAd-p53 combined with RT were 7.5% (P = .34) and 11.7% (P = .21) higher than those of the group receiving RT alone. No dose-limiting toxicity or adverse events appeared, except for transient fever after rAd-p53 administration. CONCLUSION In patients with NPC, rAd-p53 was safe and biologically active. Our results indicated that rAd-p53 improves radiotherapeutic tumor control and survival rate in patients with NPC.
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Affiliation(s)
- Jian-ji Pan
- Department of Radiotherapy, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Haidian District, Beijing, People's Republic of China
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Ng WT, Chan SH, Lee AW, Lau KY, Yau TK, Hung WM, Lee MC, Choi CW. Parapharyngeal Extension of Nasopharyngeal Carcinoma: Still a Significant Factor in Era of Modern Radiotherapy? Int J Radiat Oncol Biol Phys 2008; 72:1082-9. [DOI: 10.1016/j.ijrobp.2008.02.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 01/31/2008] [Accepted: 02/13/2008] [Indexed: 11/26/2022]
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Evaluation of Sixth Edition of AJCC Staging System for Nasopharyngeal Carcinoma and Proposed Improvement. Int J Radiat Oncol Biol Phys 2008; 70:1115-23. [DOI: 10.1016/j.ijrobp.2007.07.2353] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 07/30/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
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Chua DTT, Wei WI, Sham JST, Hung KN, Au GKH. Stereotactic Radiosurgery Versus Gold Grain Implantation in Salvaging Local Failures of Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2007; 69:469-74. [PMID: 17869663 DOI: 10.1016/j.ijrobp.2007.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 03/02/2007] [Accepted: 03/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Limited local failure of nasopharyngeal carcinoma (NPC) can often be salvaged by reirradiation using different techniques. Both gold grain implantation (GGI) and stereotactic radiosurgery (SRS) have been used as salvage treatment of NPC but the relative efficacy of these two treatments is not known. METHODS AND MATERIALS A total of 74 patients with local NPC failure were included in this retrospective analysis. Of these patients, 37 underwent SRS (median dose, 12.5 Gy) and 37 split-palatal GGI at a dose of 60 Gy. The two groups were individually matched for prognostic factors, except for tumor volume. The median follow-up was 42 months. RESULTS Local control was better in the GGI group. The 3-year local failure-free rate was 77.9% for the GGI group compared with 68.3% for the SRS group. However, the difference was not statistically significant (p = 0.098). In the subgroup with a tumor volume of <or=5 cm3, the 3-year local failure-free rates were similar, with 79.3% in the GGI group and 72.4% in the SRS group. Neuroendocrine complications were more common in the SRS group, and headache and fistula were more common in the GGI group. CONCLUSION Stereotactic radiosurgery and GGI are both effective salvage treatment for NPC. In patients with limited local failure, both yielded comparable high tumor control rates.
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Affiliation(s)
- Daniel T T Chua
- Department of Clinical Oncology, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
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Lang BHH, Chow SM, Lo CY, Law SCK, Lam KY. Staging systems for papillary thyroid carcinoma: a study of 2 tertiary referral centers. Ann Surg 2007; 246:114-21. [PMID: 17592299 PMCID: PMC1899202 DOI: 10.1097/01.sla.0000262785.46403.9b] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To find out the most applicable and consistent staging system for papillary thyroid carcinoma (PTC) available in the literature. BACKGROUND The commonly used staging systems for PTC have predicted cancer-specific survival (CSS) well. However, their applicability and generalizability have not yet been evaluated in different clinical settings. METHODS A MEDLINE search from 1965 to 2005 was carried out to identify different staging systems available in the literature and 9 systems were applicable to 1634 PTC patients within 2 tertiary-referral centers. The CSS of each staging system within individual centers were calculated using Kaplan-Meier method and the CSS of each tumor stage in one individual center was compared with that of the other by log-rank test. In addition, within each center, the predictability of each staging system relative to the others was ranked based on the proportion of variation explained (PVE) value. RESULTS Clinicopathologic features, treatment received, and tumor stages were significantly different between the 2 centers. There were also significant differences in CSS within at least one tumor stage between the 2 centers in 8 of the 9 staging systems. The TNM was a highly predictive and consistent staging system within the 2 centers. Although the absolute PVE values differed between the 2 centers, the relative ranking of the 9 staging systems within each center correlated significantly to each other (P < 0.05). CONCLUSIONS Despite referral, treatment, and data collection biases inherent within each center, the TNM system remained to be the most applicable and consistent staging system for PTC in 2 centers managing the same population group.
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Affiliation(s)
- Brian Hung-Hin Lang
- From the *Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China
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Lu JC, Wei BQ, Chen WZ, Qian PD, Zhang YQ, Wei Q, Cha WW, Li F, Ni M. Staging of nasopharyngeal carcinoma investigated by magnetic resonance imaging. Radiother Oncol 2006; 79:21-6. [PMID: 16626827 DOI: 10.1016/j.radonc.2006.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 03/23/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the American Joint Commission on Cancer (AJCC) sixth edition staging system of nasopharyngeal carcinoma (NPC) by Magnetic Resonance Imaging (MRI). PATIENTS AND METHODS One hundred and fifty-nine non-disseminated biopsy-proven NPC patients were studied with MRI before treatment. Retrieval of MRI information enabled us to restage all patients accurately according to the sixth edition of the AJCC staging system. Splitting the respective T and N stages by the significant defining factors identified, the cancer death hazard ratios were modeled by the Cox model in SPSS 10.0 for windows (SPSS Inc, Chicago, IL). RESULTS Single site of skull base abnormality (HR = 3.91, 95% CI: 0.74-20.56) has a superior result to others involved in T3 (HR = 5.83, 95% CI: 1.24-27.29). Involvement of either anterior or posterior cranial nerves solely (HR = 6.02, 95% CI: 1.55-35.60) was not found to be as a poor prognostic indicator as others involved in T4 (HR = 7.81, 95% CI: 1.81-33.63). Less than or equal to 3 cm of N1 (HR = 4.01, 95% CI: 0.48-33.83) and N2 (HR = 4.72, 95% CI: 0.62-35.78) have a better result than >3 cm of N1 (HR = 8.09, 95% CI: 0.95-68.97) and N2 (HR = 10.58, 95% CI: 1.32-84.62), respectively. CONCLUSIONS Perhaps, it is better to down-stage single site of skull base abnormality from T3 to T2, and involvement of either anterior or posterior cranial nerves solely from T4 to T3, meanwhile, < or =3 cm of N2 down-stage to N1, >3 cm of N1 up-stage to N2.
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Affiliation(s)
- Jin-Cheng Lu
- Department of Radiotherapy, Jiangsu Cancer Hospital, Nanjing, China.
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Lee AWM, Sze WM, Au JSK, Leung SF, Leung TW, Chua DTT, Zee BCY, Law SCK, Teo PML, Tung SY, Kwong DLW, Lau WH. Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys 2005; 61:1107-16. [PMID: 15752890 DOI: 10.1016/j.ijrobp.2004.07.702] [Citation(s) in RCA: 438] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Revised: 07/12/2004] [Accepted: 07/13/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To analyze the treatment results achievable for nasopharyngeal carcinoma in the modern era to identify the key failures for future improvement and to provide an updated baseline for future trials. METHODS AND MATERIALS The results of 2687 consecutive patients treated at all public oncology centers in Hong Kong during 1996-2000 were retrospectively analyzed. The stage distribution (by American Joint Committee on Cancer and International Union Against Cancer staging system, 1997) was 7% Stage I, 41% Stage II, 25% Stage III, and 28% Stage IVA-B. All patients were irradiated with 6-MV photons and the median total dose was 66 Gy. Only 23% of patients had additional treatment with chemotherapy. RESULTS The 5-year local, nodal, and distant failure-free rates were 85%, 94%, and 81%, respectively; patients with local failure had significantly higher risk of nodal and distant failures. The 5-year progression-free, overall, and cancer-specific survival rates were 63%, 75%, and 80%, respectively. The presenting stage was the most important prognostic factor for all endpoints: with overall survival decreasing from 90% for Stage I to 58% for Stage IVA-B. The results achieved by the 2070 patients treated by radiotherapy alone were almost identical to that of the whole series, the distant failure-free rate among patients with locoregional control was 89% for Stage I-II and 75% for Stage III-IVB. The 860 patients (32%) staged with magnetic resonance imaging achieved significantly better results than those staged by computed tomography, the overall survival being 93% vs. 83% for Stages I-II, and 72% vs. 63% for Stages III-IVB (p = 0.001). CONCLUSIONS Treatment results for nasopharyngeal carcinoma have substantially improved in the modern era; future trials should be based on updated baseline results. Further reduction of distant failure is important for future breakthrough, particularly for patients with advanced disease.
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Affiliation(s)
- Anne W M Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, China.
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Boussen H, Bouaouina N, Mokni-Baizig N, Gamoudi A, Chouchane L, Benna F, Ladgham A. Les carcinomes du nasopharynx : données actuelles. ACTA ACUST UNITED AC 2005; 53:45-51. [PMID: 15620610 DOI: 10.1016/j.patbio.2004.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Accepted: 01/19/2004] [Indexed: 10/26/2022]
Abstract
Nasopharyngeal carcinoma (NPC) represents an interesting model in the field of head and neck cancers. This cancer is rare in occidental countries (<1/100,000) and relatively moderate to highly frequent in the Mediterranean area and south-east Asia. This disease is linked to Epstein-Barr virus with a latent infection starting in the oropharyngeal epithelium and involving not only both epithelial tumor cells but also B lymphocytes. This viral infection represents the early phase of carcinogenesis where Latent Membrane Protein-1 has an important role via the terminal part of the BARF-1 gene. There are also various chromosomal alterations reported in NPC concerning the regions of chromosomes 3p, 9p, 11q, 13q, 14q et 16q detected essentially in areas of suppressors genes. Allelic and antigenic specificities of class II and II HLA seems to be associated to an increased risk of NPC different according to the incidence areas. Anti-EBV serology is suggestive of for NPC with an elevated level of IgA EA (early antigen) and VCA (viral capsid antigen). Cyfra 21 represents a promising serum marker for NPC with a 80% sensitivity. Radiotherapy remains the base of loco-regional treatment with a more frequent and systematic use of systemic chemotherapy (primary or concomitant) for high-risk-patients (T3-4 and N2-3 disease).
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Affiliation(s)
- H Boussen
- Service de carcinologie médicale, institut Salah-Azaïz, boulevard du 9-avril, Bâb-Saadoun, Tunis, Tunisie.
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Abstract
PURPOSE To review the clinical profiles of patients having nasopharyngeal carcinoma (NPC) with orbital invasion, which occurs more frequently in patients with Chinese and south-east Asian racial backgrounds. Although this disease frequently spreads superiorly to the skull base and intracranium, it rarely invades the orbit and we wish to examine some cases in which it has. METHODS In this observational case series, we examined 406 patients, who were diagnosed with orbital tumour at Taipei Veterans General Hospital between January 1974 and December 2001. In all, 13 of the patients (11 males, two females) were found to have NPC with orbital invasion. Neuroimaging studies, pathologic reports, and clinical courses of these 13 patients were then reviewed retrospectively and survival analysis was carried out using a Kaplan-Meier estimate. RESULTS One patient presented with eyelid tumour and three other patients presented with proptosis as the initial manifestation of NPC. The other nine cases, already diagnosed to have NPC, visited our department with a variety of ocular symptoms and signs, such as proptosis, diplopia, visual impairment, and orbital pain. Palliative treatment with radiotherapy alone or in combination with chemotherapy was given in 12 cases. During the follow-up period ranging from 4 to 64 months, six patients died, one was lost during follow-up, and six were still alive. CONCLUSIONS Although orbital invasion in NPC is rare, we found a 5-year survival rate of 28% in our patients, indicating that orbital invasion with NPC confers a particularly poor prognosis.
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Affiliation(s)
- W-M Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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