The effect of primary tumor volume on the prognosis of nasopharyngeal carcinoma in era of volumetric modulated arc therapy: a propensity score matched cohort study

Lin, Xiang; Wang, Bingyi; Zheng, Fei; Fei, Zhaodong; Chen, Chuanben

doi:10.1016/j.bjorl.2023.02.002

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Brazilian Journal of Otorhinolaryngology

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Sumário

Original article • Braz. j. otorhinolaryngol. 89 (3) • May-Jun 2023 • https://doi.org/10.1016/j.bjorl.2023.02.002 copy

The effect of primary tumor volume on the prognosis of nasopharyngeal carcinoma in era of volumetric modulated arc therapy: a propensity score matched cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Propensity score matching was used to reduce bias in the study.
PTV was an important independent predictor on survival for NPC patients receiving VMAT.
PTV > 38 mL may be considered as an indicator of the clinical stage of nasopharyngeal carcinoma.

Abstract

Objective

The role of Primary Tumor Volume (PTV) in Nasopharyngeal Carcinoma (NPC) treated with Volumetric Modulated Arc Therapy (VMAT) is still unclear. The aim of this study was to access the effect of PTV in prognosis prediction of nasopharyngeal carcinoma in era of VMAT.

Methods

Between January 20 and November 2011, 498 consecutive NPC patients with stage I-IVA disease who received VMAT at a single center were retrospectively analyzed. Receiver Operating Characteristic (ROC) was performed to access the cut-off point of PTV. Univariate Kaplan-Meier and multivariate Cox regression analyses were used to evaluate prognostic value for PTV. The Propensity Score Matching (PSM) was used to adjust baseline potential confounders.

Results

The 5-year Locol-Regional Failure-Free (L-FFR), Distant Failure-Free Survival (D-FFR), Disease-Free Survival (DFS) and Overall Survival (OS) were 90.6%, 83.7%, 71.5% and 79.3%, respectively. Before PSM, the 5-year L-FFR, D-FFR, DFS, OS rates for NPC patients with PTV ≤ 38 mL vs. PTV > 38 mL were 94.1% vs. 90.4% (p= 0.063), 87.9% vs. 76.3% (p< 0.001), 78.5% vs. 58.5% (p< 0.001) and 86.3% vs. 66.7% (p< 0.001) respectively. Multivariate analysis showed PTV was an independent prognostic factor for D-FFS (p= 0.034), DFS (p= 0.002) and OS (p= 0.001). PTV classified was still an independent prognostic factor for OS after PSM (HR = 2.034, p= 0.025.

Conclusions

PTV had a substantial impact on the prognosis of NPC patients treated with VMAT before and after PSM simultaneously. PTV > 38 mL may be considered as an indicator of the clinical stage of nasopharyngeal carcinoma.

Level of evidence

III.

Keywords
Primary tumor volume; Prognosis; Nasopharyngeal carcinoma; Propensity score matching; Volumetric modulated arc therapy

Characteristic	Number of patient (%)
Age (years)
≤50	322 (64.7%)
>50	176 (35.3%)
Gender
Male	383 (76.9)
Female	115 (23.1%)
Kps score
≤80	19 (3.8%)
90	479 (96.2%)
Radiotherapy Interruption (days)
<5	454 (91.2%)
≥5	44 (8.8%)
Boost
Yes	151 (30.3%)
No	347 (69.7%)
T-stage
T1	39 (7.8%)
T2	149 (29.9%)
T3	214 (43.0%)
T4	96 (19.3%)
N-stage
N0	127 (25.5%)
N1	242 (48.6%)
N2	106(21.3%)
N3	23 (4.6%)
TNM stage
I	11 (2.2%)
II	128 (25.7%)
III	248 (49.8%)
IV	111 (22.3%)
Con-CT
Yes	122 (24.5%)
No	376 (75.5%)
PTV
≤38 mL	321 (64.5%)
>38 mL	177 (35.5%)

Variable		Before PSM			After PSM
Variable		PTV ≤ 38 mL	PTV > 38 mL	p-value	PTV ≤ 38 mL	PTV > 38 mL	p-value
Gender	Male	232 (72.2)	151 (85.3)	0.001	79 (76.7)	83 (80.6)	0.497
Gender	Female	89 (27.8)	26 (14.7)		24 (23.3)	20 (19.4)
Age	≤50 y	116 (36.1)	118 (66.7)	<0.001	68 (66.0)	74 (71.8)	0.366
Age	>50 y	205 (63.9)	59 (33.3)		35 (34.0)	29 (28.2)
N-stage	N0	82 (25.5)	45 (25.4)	0.046	28 (27.2)	24 (23.3)	0.830
	N1	168 (52.3)	74(41.8)		43 (41.7)	41 (39.8)
	N2	57 (17.8)	49 (27.7)		31 (30.1)	37 (35.9)
	N3	14 (4.4)	9 (5.1)		1 (1.0)	1 (1.0)
T-stage	T1	35 (10.9)	4 (2.3)	<0.001	4 (3.9)	4 (3.9)	0.571
	T2	131 (40.8)	18 (10.2)		14 (13.6)	18 (17.5)
	T3	132 (41.1)	82 (46.3)		65 (63.1)	68 (66.0)
	T4	23 (7.2)	73(41.2)		20 (19.4)	13 (12.6)
KPS score	≤80	4 (0.9)	15 (8.4)	<0.001	2 (2.0)	3 (3.0)	1.000
KPS score	90	318 (99.1)	162 (91.6)		101 (98.0)	100 (97.0)
Con-CT	Yes	70 (21.8)	52 (29.4)	0.06	29 (28.2)	35 (34.0)	0.366
Con-CT	No	251 (78.2)	125 (70.6)		74 (71.8)	68 (66.0)
Int	Yes	19 (5.9)	15 (8.5)	0.279	8 (7.8)	9 (8.7)	1.000
Int	No	302 (94.1)	162 (91.5)		95 (92.2)	94 (91.3)
Boost	Yes	87 (27.1)	64 (36.2)	0.035	35 (34.0)	37(	0.770
Boost	No	234 (72.9)	113 (63.8)		68 (66.0)	66 (64.0)

Variable		5-year L-FFR (%)	p-value	5-year D-FFS (%)	p-value	5-year DFS (%)	p-value	5-year OS (%)	p-value
Gender	Male	90.4	0.671	83.1	0.186	70.4	0.063	78.7	0.128
Gender	Female	91.3		87.8		78.3		82.6
Age	≤50 y	92.3	0.037	84.3	0.735	76.9	0.001	84.6	<0.001
Age	>50 y	87.5		84.1		63.6		70.5
N-stage	N0	94.5	0.257	91.3	<0.001	81.9	<0.001	86.6	0.004
	N1	89.3		88.5		74.5		81.1
	N2	89.6		68.9		57.5		70.8
	N3	87.5		70.8		62.5		66.7
T-stage	T1	92.3	0.336	92.3	0.031	84.6	<0.001	94.9	<0.001
	T2	91.9		87.2		79.2		85.2
	T3	91.1		84.1		71.5		79.4
	T4	86.7		76.5		58.2		65.3
KPS score	≤80	94.7	0.761	73.7	0.189	52.6	0.054	63.2	0.105
KPS score	90	92.7		84.1		72.2		80.0
Con-CT	Yes	90.2	0.735	85.7	0.106	73.3	0.218	79.5	0.895
Con-CT	No	90.7		79.5		68.9		79.3
Int	Yes	90.1	0.193	84.1	0.860	79.4	0.397	79.4	0.697
Int	No	97.1		85.3		71.7		82.4
Boost	Yes	91.7	0.218	85.6	0.210	64.5	0.025	73.0	0.030
Boost	No	88.2		80.9		75.6		82.5
PTV	≤38 mL	94.1	0.063	87.9	<0.001	78.5	<0.001	86.3	<0.001
PTV	>38 mL	90.4		76.3		58.5		66.7

Variable	5-year L-FFR		5-year D-FFS		5-year DFS		5-year OS
Variable	HR (95% CI)	p	HR (95% CI)	p	HR (95% CI)	p	HR (95% CI)	p
Age	1.681 (0.863‒3.273)	0.126	1.155 (0.727‒1.835)	0.542	1.853 (1.326‒2.590)	<0.001	2.318 (1.568‒3.425)	<0.001
N-stage
N0‒1 vs. N2‒3	1.393 (0.678‒2.862	0.367	2.814 (1.803‒4.392)	<0.001	1.954 (1.381‒2.767)	0.001	1.941 (1.296‒2.908)	0.001
T-stage
T1‒2 vs. T3‒4	1.977 (0.859‒4.547)	0.109	1.413 (0.834‒2.394)	0.199	1.414 (0.948‒2.111)	0.090	1.530 (0.938‒2.498	0.089
PTV
≤38 mL vs. >38 mL	1.452 (0.720‒2.928)	0.297	1.671 (1.040‒2.686	0.034	1.772 (1.237‒2.539	0.002	2.298 (1.504‒3.512)	<0.001
Con-CT	0.985 (0.456‒2.130)	0.969	0.818 (0.508‒1.318)	0.410	0.895 (0.614‒1.305)	0.583	1.081 (0.683‒1.712)	0.739

Variable	5-year L-FFR		5-year D-FFS		5-year DFS		5-year OS
Variable	HR (95% CI)	p	HR (95% CI)	p	HR (95% CI)	p	HR (95% CI)	p
Age	0.874 (0.235‒3.249)	0.841	1.315 (0.686‒2.520)	0.409	1.832 (1.106‒3.036)	0.019	2.375 (1.309‒4.309)	0.004
N-stage
N0‒1 vs. N2‒3	1.092 (0.328‒3.639)	0.886	2.275 (1.226‒4.223)	0.009	1.552 (0.935‒2.576)	0.089	1.708 (0.933‒3.124)	0.083
T-stage
T1‒2 vs. T3‒4	2.750 (0.350‒6.601	0.336	1.326 (0.582‒3.021)	0.501	1.433 (0.723‒2.837)	0.302	1.517 (0.670‒3.432)	0.317
PTV
≤38 mL vs. >38 mL	1.110 (0.355‒3.468)	0.858	1.293 (0.693‒2.411)	0.419	1.408 (0.852‒2.329)	0.182	2.034 (1.092‒3.786)	0.025
Con-CT	0.938 (0.278‒3.157)	0.917	1.192 (0.602‒2.359)	0.614	0.987 (0.577‒1.691)	0.963	1.354 (0.678‒2.704)	0.390

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] ⁎ Corresponding author. E-Mail:chchben@sina.cn (C. Chen).