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Background <p>For patients with locally advanced nasopharyngeal carcinoma (LA-NPC), the optimal number of cycles of induction chemotherapy (IC) remains uncertain. This study aimed to assess the efficiency and toxicity of different cycles of IC in LA-NPC patients.</p> Methods <p>This retrospective study included 210 patients with LA-NPC and compared clinical outcomes and toxicity in two groups: 129 patients received two cycles of IC plus concurrent chemoradiotherapy (CCRT), and 81 patients received three cycles of IC plus CCRT. Propensity score matching was employed to mitigate selection bias and enhance the comparability of the two cohorts. Survival analysis was conducted using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression analyses.</p> Results <p>Propensity score matching identified 81 matched pairs of patients. No significant differences were observed between the two-cycle and three-cycle groups regarding 5-year overall survival (OS) rates (88.1% vs. 80.4%, <i>p</i> = 0.21), 5-year locoregional relapse-free survival (LRRFS) rates (91.8% vs. 94.7%, <i>p</i> = 0.51), 5-year distant metastasis-free survival (DMFS) rates (80.9% vs. 84.8%, <i>p</i> = 0.55), or 5-year progression-free survival (PFS) rates (73.4% vs. 79.7%, <i>p</i> = 0.4). However, the three-cycle group had a greater incidence of grade 3/4 treatment-related acute toxicity, with the difference being significant during CCRT but not IC. Multivariate analysis identified stage IVa as an independent prognostic factor for OS, while LDH levels ≥ 245 U/L were independent predictors of poorer DMFS and PFS.</p> Conclusion <p>For patients with LA-NPC, three cycles of IC did not significantly improve patients’ survival compared to two cycles of IC but rather increased the incidence of toxicity.</p>

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Comparative efficacy and toxicity of two versus three induction chemotherapy cycles in locally advanced nasopharyngeal carcinoma: a propensity score matching analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Renxian Xie,
  • Xiaoluan Lin,
  • Qiufeng Li,
  • Junqing Pan,
  • Keyan Xie,
  • Jianzhou Chen,
  • Ying Zhang,
  • Chuangzhen Chen,
  • Yizhou Zhan

摘要

Background

For patients with locally advanced nasopharyngeal carcinoma (LA-NPC), the optimal number of cycles of induction chemotherapy (IC) remains uncertain. This study aimed to assess the efficiency and toxicity of different cycles of IC in LA-NPC patients.

Methods

This retrospective study included 210 patients with LA-NPC and compared clinical outcomes and toxicity in two groups: 129 patients received two cycles of IC plus concurrent chemoradiotherapy (CCRT), and 81 patients received three cycles of IC plus CCRT. Propensity score matching was employed to mitigate selection bias and enhance the comparability of the two cohorts. Survival analysis was conducted using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression analyses.

Results

Propensity score matching identified 81 matched pairs of patients. No significant differences were observed between the two-cycle and three-cycle groups regarding 5-year overall survival (OS) rates (88.1% vs. 80.4%, p = 0.21), 5-year locoregional relapse-free survival (LRRFS) rates (91.8% vs. 94.7%, p = 0.51), 5-year distant metastasis-free survival (DMFS) rates (80.9% vs. 84.8%, p = 0.55), or 5-year progression-free survival (PFS) rates (73.4% vs. 79.7%, p = 0.4). However, the three-cycle group had a greater incidence of grade 3/4 treatment-related acute toxicity, with the difference being significant during CCRT but not IC. Multivariate analysis identified stage IVa as an independent prognostic factor for OS, while LDH levels ≥ 245 U/L were independent predictors of poorer DMFS and PFS.

Conclusion

For patients with LA-NPC, three cycles of IC did not significantly improve patients’ survival compared to two cycles of IC but rather increased the incidence of toxicity.