ABSTRACT: BACKGROUND:To estimate the efficacy of neoadjuvant chemotherapy (NCT) in stage T3-4N1 nasopharyngeal carcinoma (NPC). METHODS:Data on stage T3-4N1 NPC patients treated with concurrent chemoradiotherapy (CCRT) with or without NCT at the Sun Yat-sen University Cancer Center between January 2006 and December 2013 were retrospectively reviewed. Propensity score matching (PSM) was carried out to balance prognostic factors in NCT followed by CCRT (NCT?+?CCRT) group and CCRT group in a 1:1 ratio. Survival outcomes of matched patients in the two groups were compared, and prognostic factors were identified using Cox regression model. RESULTS:A total of 282 patients were involved in this study, with 136 of NCT?+?CCRT group and 146 of CCRT group. After PSM, 85 pairs of patients were selected. There were no significant differences in 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and recurrence-free survival (RFS) between NCT?+?CCRT group and CCRT group (81.0% vs. 77.5%, P =?0.750; 85.8% vs. 88.1%, P =?0.495; 92.5% vs. 93.9%, P =?0.759; 81.0% vs.77.5%, P =?0.919, respectively). Multivariate analysis found that smoking history (P =?0.044) and T classification (P =?0.027) were independent prognostic factors for OS, lymph node diameter (P =?0.032) was independent prognostic factor for LRFS, positive pretreatment lymph node condition (PLNC), which was defined as the lymph node necrosis or confluent, was independent prognostic factor for DRFS (P =?0.007), and RFS (P =?0.009). Lower 5-year OS (82.7% vs. 94.1%, P =?0.014), DRFS (79.3% vs. 96.2%, P =?0.003), and RFS (62.4% vs. 86.8%, P =?0.001) were found in positive PLNC group compared with negative PLNC group. In terms of toxicities, the incidences of acute hematological Grade 3-4 adverse events (AEs) were higher in NCT?+?CCRT group compared with CCRT group (P ?0.05). CONCLUSIONS:Additional NCT is not associated with improved survival outcomes for patients with stage T3-4N1 NPC, but bring increased hematological Grade 3-4 AEs. PLNC is independent prognostic factor in stage T3-4N1 NPC, with positive PLNC correlating with poor survival outcomes.
