scholarly journals Oncological outcome of patients with salivary gland cancer treated with surgery and postoperative intensity-modulated radiotherapy: a retrospective study

2020 ◽  
Author(s):  
Shoumei Zang ◽  
Meiqin Chen ◽  
Huijie Huang ◽  
Xinli Zhu ◽  
Danfang Yan ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Multivariable Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Oncological Outcome ◽  
Rank Test ◽  
Salivary Gland Cancer ◽  
Significant Prognostic Factor ◽  
Free Survival ◽  
Intensity Modulated

Abstract Background Salivary gland cancer (SGC) is comparatively rare and constitutes a variety of histological subtypes. Previously published studies included SGC patients who were irradiated using conventional radiotherapy or 3-dimensional conformal radiotherapy (3-DCRT) may have led to suboptimal oncological outcomes. Methods We identified 60 patients with major SGC treated with surgery followed by postoperative intensity-modulated radiotherapy (IMRT). Data for overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), prognostic factors, and treatment-related toxicities were analyzed. Survival was analyzed using the Kaplan–Meier method and compared using the log-rank test. Results Adenoid cystic carcinoma (ACC) was the most common histology (n = 21; 35%). With a median follow-up of 55.5 months, OS and PFS were 90.7%, 85.1%, and 85.1%; and 80.1%, 72.7%, and 63.1%, at 3, 5, and 10 years, respectively. LRRFS and DMFS at 3, 5, and 10 years were 87.4%, 82.1%, and 82.1%; and 85.3%, 78.4%, and 66.1%, respectively. Five-year OS, PFS, LRRFS, and DMFS for ACC was 100%, 67.7%, 76.2%, and 90.2%, respectively. In multivariable analysis (MVA), N stage was an independent predictor of PFS (p = 0.047). Positive margin was a significant prognostic factor for PFS, LRRFS, and DMFS (p = 0.036, 0.026, and 0.011, respectively). Major nerve involvement was significantly correlated with PFS and DMFS (p = 0.034 and 0.008, respectively). Interval from surgery to radiotherapy (RT) predicted PFS and DMFS (p = 0.036 and 0.012, respectively). The most common acute toxicities were mucositis and dermatitis, and xerostomia was the most common late adverse event. Lung metastasis was the most common pattern of distant failure. Conclusion Postoperative IMRT leads to improved survival for SGC patients with acceptable toxicities.

scholarly journals Oncological outcome of patients with salivary gland cancer treated with surgery and postoperative intensity-modulated radiotherapy: a retrospective study

2020 ◽  
Author(s):  
Shoumei Zang ◽  
Huijie Huang ◽  
Xinli Zhu ◽  
Meiqin Chen ◽  
Danfang Yan ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Prognostic Factors ◽  
Multivariable Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Oncological Outcome ◽  
Salivary Gland Cancer ◽  
Significant Prognostic Factor ◽  
Free Survival ◽  
Intensity Modulated

Abstract Background To investigate the outcomes, prognostic factors, patterns of failure, and adverse events in patients with salivary gland cancer (SGC) treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). Methods We identified 60 patients with major SGC treated with surgery followed by postoperative IMRT. Data for overall survival (OS),progression-free survival (PFS), locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), prognostic factors, and treatment-related toxicities were analyzed. Survival was calculated with the Kaplan–Meier method. Multivariable analysis (MVA) was used to identify prognostic factors for OS, PFS, LRRFS and DMFS. Results Adenoid cystic carcinoma (ACC) was the most common histology ( n =21; 35%). With a median follow-up of 55.5 months, OS and PFS were 90.7%, 85.1%, and 85.1%; and 80.1%, 72.7%, and 63.1%, at 3, 5, and 10 years, respectively. LRRFS and DMFS at 3, 5, and 10 years were 87.4%, 82.1%, and 82.1%; and 85.3%, 78.4%, and 66.1%, respectively. Five-year OS, PFS, LRRFS, and DMFS for ACC was 100%, 67.7%, 76.2%, and 90.2%, respectively. In MVA, N stage was an independent predictor of PFS ( p =0.047). Positive margin was a significant prognostic factor for PFS, LRRFS, and DMFS ( p =0.036, 0.026, and 0.011, respectively). Major nerve involvement was significantly correlated with PFS and DMFS ( p =0.034 and 0.008, respectively). Interval from surgery to radiotherapy (RT) predicted PFS and DMFS ( p =0.036 and 0.012, respectively). The most common acute toxicities were mucositis and dermatitis, and xerostomia was the most common late adverse event. Lung metastasis was the most common pattern of distant failure. Conclusion Postoperative IMRT leads to improved survival for SGC patients with acceptable toxicities.

NTRK, ALK and RET rearrangements in salivary gland cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18023-e18023
Author(s):  
Svetlana Kutukova ◽  
Evgeny Imyanitov ◽  
Natalia P. Beliak ◽  
Julia V. Ivaskova ◽  
Alexandra Razumova
Keyword(s):  
Overall Survival ◽  
Salivary Gland ◽  
Poor Prognosis ◽  
Progression Free Survival ◽  
Rank Test ◽  
Salivary Gland Cancer ◽  
Prognosis Factor ◽  
Free Survival ◽  
Kaplan Meier ◽  
The Impact

e18023 Background: We investigated the prevalence of rare genes rearrangements in salivary gland adenocarcinomas and the impact of these fusions on overall survival (OS) and progression free survival (PFS). Methods: For 51/60 (85.0%) patients with different types salivary gland adenocarcinomas (stage I-IVA), sufficient tumor tissue was available for molecular characterization by polymerase chain reaction (PCR) and has been tested for NTRK, ALK, ROS1, RET and MET deletion. OS and PFS curves were estimated with the Kaplan-Meier method and compared using the log-rank test. Results: Two cases (3.92%) of NTRK translocation were found, both are a classic rearrangement of ETV6ex5; NTRK3ex15. Of the other alterations, 2 cases (3.92%) of unbalanced ALK expression. However, it was not possible to establish the option of rebuilding. In addition, were found 2 cases (3.92%) of highly balanced expression of NTRK2 and ALK, and one case (1.96%) of high expression of ROS1. RET mRNA expression was detected in 13 of 48 cases (27.08%). NTRK, RET, ALK and ROS1 fusions were equally common in both men and women (p = 0.89), not depending on age (0.76). All patients bearing ALK, RET and NTRK fusions had shorter overall survival - 13.2 months, 95% confidence interval [CI] 13.0 to 32.0 months in multivariable model 105.0 moth (95% CI 105.0-105.0) in patient's group without mutations (p = 0.1817); and shorter PFS: 5.0 month (95% CI 5.0-16.0) vs not reached PFC in group (mean of PFS 63.15±5.58; 95% CI 52.20-74.09) without mutations (p = 0.0467). ALK fusion is an independent poor prognosis factor affecting on OS: p = 0.0168, hazard ratio (HR) = 8.65 (95% CI 1.47-50.77); and poor prognosis factor affecting on PFS: p = 0.0170, HR = 7.13 (95% CI 1.42-35.80). Conclusions: ALK, NTRK, ROS1 and RET mutations define a new rare subtype of salivary gland adenocarcinomas with enormously poor prognosis. The presence ALK-mutation is an independent poor prognosis factorб negatively affecting both overall survival and progression-free survival. It’s advisable to consider the possibilities of using ALK, NTRK and RET inhibitors in this cohort of patients.

scholarly journals Survival Benefit with Standard-Dose Decitabine Versus Standard-Dose Azacitidine in Patients with Lower-Risk Myelodysplastic Syndromes

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3099-3099
Author(s):  
Byung-Hyun Lee ◽  
Ka-Won Kang ◽  
Min Ji Jeon ◽  
Eun Sang Yu ◽  
Dae Sik Kim ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Efficacy ◽  
Myelodysplastic Syndromes ◽  
Lower Risk ◽  
Standard Dose ◽  
Multivariable Analysis ◽  
Progression Free Survival ◽  
Significant Prognostic Factor ◽  
Free Survival ◽  
Treatment Responses

Abstract Introduction: Hypomethylating agents (HMAs) are used for the treatment of patients with myelodysplastic syndromes (MDS). Two HMAs, decitabine and azacitidine, are currently available for such treatment. Numerous studies have analyzed the clinical efficacy of HMAs in patients with MDS; however, reports directly comparing decitabine and azacitidine in patients with lower-risk (low and intermediate-1) MDS are limited. The clinical efficacy of standard-dose HMA treatment in lower-risk MDS remains controversial. Patients and methods: The Korea University MDS registry is a longitudinal cohort that contains data on 452 patients consecutively diagnosed with MDS from October 2006 to December 2017 in Korea University Medical Center (Korea University Anam, Guro, and Ansan Hospital). In the Korea University MDS registry, 357 patients were classified as having lower-risk MDS. Among them, 115 patients were treated with HMA (decitabine or azacitidine); 111 patients were eligible for the study. We compared treatment responses, survival outcomes, and adverse events between standard-dose decitabine (20 mg/m2 daily for 5 days every 4 weeks) and azacitidine (75 mg/m2 daily for 7 days every 4 weeks) in lower-risk MDS patients. Treatment responses were assessed according to the modified 2006 International Working Group response criteria. Patients who were evaluated received at least one cycle of HMA therapy. The overall response rate (ORR) included complete remission (CR), partial remission, marrow CR, and hematologic improvement. Progression-free survival (PFS) was measured from the time of treatment initiation until disease progression or death from MDS. Results: The CR rates were 16.4% (10/61) in the decitabine group and 6.0% (3/50) in the azacitidine group with borderline significance (P = .090). The ORRs were 67.2% (41/61) and 44.0% (22/50) for decitabine and azacitidine, respectively (P = .014). The erythroid responses for decitabine and azacitidine were 68.3% (41/60) and 44.2% (19/43), respectively (P = .014). In the multivariable analysis, treatment with decitabine (hazard ratio [HR] 2.553; 95% confidence interval [CI] 1.116-5.840; P = .026), hemoglobin (Hb) concentration of <8 g/dL (HR 3.073; 95% CI 1.340-7.048; P = .008), and ≥5% BM blasts (HR 3.739; 95% CI 1.102-12.683; P = .034) were significantly associated with higher ORRs. The median progression-free survival was significantly better in patients treated with decitabine than in those treated with azacitidine (33 vs. 19 months; P = .019). There were no significant differences in the event-free survival and in the overall survival between the two HMAs. In the multivariable analysis, treatment with decitabine (HR 0.496; 95% CI 0.257-0.957; P = .037) and achievement of CR (HR 0.122; 95% CI 0.015-0.993; P = .049) were significant prognostic factors for better survival, whereas ANC below 0.8 × 109/L (HR 1.905; 95% CI 1.032-3.515; P = .039) was a significant prognostic factor for poor prognosis. The poor cytogenetic risk group, as classified by International Prognostic Scoring System (HR 2.136; 95% CI 0.992-4.556; P = .052), also affected the survival unfavorably with borderline significance. There were no significant differences in grade 3 or higher hematologic adverse events between the two HMAs. Conclusions: The standard-dose decitabine therapy showed significantly better ORR, erythroid response, and longer PFS than did standard-dose azacitidine in patients with lower-risk MDS. The frequencies of hematologic adverse events did not differ between the patients who received decitabine and those who received azacitidine. Disclosures No relevant conflicts of interest to declare.

Toripalimab plus intensity-modulated radiotherapy for recurrent nasopharyngeal carcinoma: An open-label single-arm, phase II trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6023-6023
Author(s):  
Mingyuan Chen ◽  
Yijun Hua ◽  
Rui You ◽  
Zhi-Qiang Wang ◽  
Peiyu Huang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Phase Ii ◽  
Phase Ii Trial ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Free Survival ◽  
Intensity Modulated ◽  
Local Surgery ◽  
Recurrent Nasopharyngeal Carcinoma ◽  
Grade 3

6023 Background: Toripalimab is a humanized immunoglobulin G4 monoclonal antibody against programmed death 1 (PD-1). We aimed to investigate the efficacy and safety of toripalimab in combination with intensity-modulated radiotherapy (IMRT) for recurrent nasopharyngeal carcinoma (rNPC). Methods: We conducted a single-arm, phase II trial with rNPC patients who had biopsy-proven disease and were unsuitable for local surgery. Eligible patients received IMRT in combination with toripalimab administered via intravenous infusion of 240 mg once every 3 weeks for a maximum of seven cycles. The primary endpoint was the objective response rate (ORR). The secondary endpoints included safety profiles, progression-free survival (PFS). Results: Between May 2019 and January 2020, a total of 25 rNPC patients were enrolled (18 men [72.0%] and 7 women [28.0%]; median [IQR] age, 49.0 [43.5-52.5] years). With a median (IQR) follow-up duration of 14.6 months (13.1-16.2) months, 19 patients (79.2%) achieved an overall response, and disease control was achieved in 23 (95.8%) patients at 3 months post radiotherapy. The 12-month progression-free survival was 91.8% (95% CI 91.7% - 91.9%). The incidences of acute (grade ≥3) blood triglyceride elevation, creatine phosphokinase elevation, skin reaction, and mucositis were 1 (4.0%), 1 (4.0%), 2 (8.0%), and 1 (4.0%), respectively. The incidences of late severe (grade ≥3) nasopharyngeal wall necrosis, nasal bleeding, and trismus were 28.0%, 12.0%, and 4.0%, respectively. Conclusions: Toripalimab combined with IMRT was tolerable and showed promising antitumor activity in rNPC patients. Clinical trial information: NCT03854838.

scholarly journals Hypofractionated intensity-modulated radiotherapy with concurrent chemotherapy for elderly patients with locally advanced pancreatic carcinoma

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Takahiro Iwai ◽  
Michio Yoshimura ◽  
Ryo Ashida ◽  
Yoko Goto ◽  
Takahiro Kishi ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Carcinoma ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Severe Toxicity ◽  
Free Survival ◽  
Intensity Modulated ◽  
Locally Advanced Pancreatic Carcinoma ◽  
Advanced Pancreatic Carcinoma

Abstract Background It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly cancer patients will increase. However, the optimal treatment for elderly patients with LAPC remains unclear. The purpose of this study was to evaluate the efficacy and safety of hypofractionated intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine for elderly patients with LAPC. Methods We retrospectively analysed the data from LAPC patients aged ≥ 75 years treated with hypofractionated IMRT (48 Gy in 15 fractions) with concurrent weekly gemcitabine at our institution from February 2013 to December 2018. Overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), and the pattern of recurrence and toxicity were analysed. Results Fifteen patients received treatment during the study period. The median age was 78 years (range 75–86 years), and the Eastern Cooperative Oncology Group (ECOG) performance status (PS) of all patients was 0–1. The median survival time (MST) and median PFS were 20.4 [95% confidence interval (CI) 10.3–36.8] and 13.5 (95% CI 6.4–20.3) months, respectively, and the 1-year OS and PFS rates were 80.0% (95% CI 50–93.1%) and 66.7% (95% CI 37.5–84.6%), respectively. The median LRPFS and median DMFS were 15.6 (95% CI 6.4–36.8) and 14.9 (95% CI 7.0–20.5) months, respectively, and the 1-year LRPFS and DMFS rates were 73.3% (95% CI 43.6–89.1%) and 66.7% (95% CI 37.5–84.6%), respectively. Non-haematologic grade 3 toxicity was observed in three cases, of which only one was induced by radiotherapy, whereas grade 4–5 non-haematologic acute or late toxicities were not observed. Conclusions The OS and PFS of elderly patients with LAPC treated using hypofractionated IMRT with concurrent gemcitabine were favourable and without the occurrence of severe toxicity. This treatment strategy is feasible and promising for elderly LAPC patients with good PS.

scholarly journals Hypofractionated Intensity-Modulated Radiotherapy with Concurrent Chemotherapy for Elderly Patients with Locally Advanced Pancreatic Carcinoma

2020 ◽  
Author(s):  
Takahiro Iwai ◽  
Michio Yoshimura ◽  
Ryo Ashida ◽  
Yoko Goto ◽  
Takahiro Kishi ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Free Survival ◽  
Intensity Modulated ◽  
Locally Advanced Pancreatic Carcinoma ◽  
Advanced Pancreatic Carcinoma ◽  
One Year ◽  
The One

Abstract Background: It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly patients with cancer has been increasing recently. However, the optimal treatment for elderly patients with LAPC is unclear. The purpose of this study was to evaluate the efficacy and safety of hypofractionated intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine for elderly patients with LAPC. Methods: We retrospectively analyzed data of LAPC patients aged ≥75 years treated with hypofractionated IMRT (48 Gy in 15 fractions), with concurrent weekly gemcitabine at our institution from February 2013 to December 2018. Overall survival (OS), progression free survival (PFS), locoregional progression free survival (LRPFS), distant metastasis free survival (DMFS) and the pattern of recurrence and toxicity were analyzed.Results: Fifteen patients were administered this treatment during the period. The median age was 78 years (range, 75-86 years), and the Eastern Cooperative Oncology Group (ECOG) performance status (PS) of all patients was 0-1. The median survival time (MST) and median PFS were 20.4 (95% confidence interval (CI) 10.3-36.8) and 13.5 (95% CI 6.4-20.3) months, respectively, and the one-year OS and PFS rates were 80.0% (95% CI 50-93.1%) and 66.7% (95% CI, 37.5-84.6%), respectively. The median LRPFS and median DMFS were 15.6 (95% CI 6.4-36.8) and 14.9 (95% CI 7.0-20.5) months, respectively, and the one-year LRPFS and DMFS rates were 73.3% (95% CI, 43.6-89.1%) and 66.7% (95% CI 37.5-84.6%), respectively. Non-hematologic grade 3 toxicity was observed in three cases of which only one was induced by radiotherapy, and grade 4-5 non-hematologic acute or late toxicities were not observed.Conclusions: The OS and PFS of elderly patients with LAPC treated using hypofractionated IMRT using gemcitabine concurrently were favorable without the occurrence of severe toxicity. This treatment strategy is feasible and promising for the elderly LAPC patients with good PS.Trial registrationRetrospectively registered.

scholarly journals Evaluation of Uterine Brachytherapy as Primary Treatment Option for Elderly Patients with Medically Inoperable Endometrial Cancer—A Single-Center Experience and Review of the Literature

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2301
Author(s):  
Nathalie Arians ◽  
Jan Tobias Oelmann-Avendano ◽  
Daniela Schmitt ◽  
Eva Meixner ◽  
Antje Wark ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
External Beam Radiotherapy ◽  
Progression Free Survival ◽  
Oncological Outcome ◽  
Primary Treatment ◽  
Rank Test ◽  
Review Of The Literature ◽  
Free Survival ◽  
Kaplan Meier ◽  
Grade Ii

We aimed to gain more evidence regarding the feasibility, toxicity, and oncological outcome of primary brachytherapy in patients with medically inoperable endometrial cancer. Thirteen patients receiving primary brachytherapy ± external beam radiotherapy (EBRT) for endometrial cancer due to medical inoperability were identified. The Kaplan–Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and local failure-free survival (LFFS). Univariate outcome analyses were performed using the log-rank test. Peri-interventional complications, acute and chronic toxicities were evaluated. Additionally, we performed a Pubmed search and review of the literature of the last 10 years. Mean age at time of diagnosis was 73.9 years (60.4–87.1 years). Eleven patients were staged FIGO IA/B and one patient each with FIGO IIIA and IIIC. Kaplan–Meier-estimated 2-/5-year LFFS were 76.2%/56.4%, respectively. High grading correlated with a worse LFFS (p = 0.069). Kaplan–Meier-estimated 2-/5-year PFS were 76.9%/53.8% and 2-/5-year-OS were 76.9%/69.2%, respectively. No acute toxicities > grade II and only two late toxicities grade II/III occurred. We observed three peri-interventional complications. The available evidence suggests high rates of local control after definitive brachytherapy for inoperable endometrial cancer with a favorable toxicity profile. Definitive brachytherapy +/− EBRT should be considered as the preferred approach for this patient group.

scholarly journals The Effect of Prolonged Duration of Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Yi-Jun Hua ◽  
Yan-Feng Ou-Yang ◽  
Xiong Zou ◽  
Le Xia ◽  
Dong-Hua Luo ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Distant Metastasis ◽  
Healthcare Providers ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Primary Treatment ◽  
Free Survival ◽  
Intensity Modulated ◽  
Distant Failure ◽  
Prolonged Duration

PurposeRadiotherapy is the most important primary treatment for patients with nasopharyngeal carcinoma. Generally, the treatment duration of radiotherapy takes six or six and half weeks with 30 to 33 fractions. The current study was conducted to evaluate the association between prognosis and the duration of radiotherapy in nasopharyngeal carcinoma patients.MethodsPatients with primary nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy and concurrent cisplatin-based chemotherapy, with or without induction chemotherapy between January, 2008 and December, 2013 at a single institution were retrospectively reviewed.ResultsIn total, 1292 patients were included. At a median follow-up of 71.0 months (range 2.0–126.0 months), locoregional recurrence, distant failure and death were observed in 8.8%, 12.2% and 15.6% of all patients, respectively. Estimated 5-year locoregional relapse–free survival, distant metastasis–free survival, progression-free survival and overall survival in patients with radiation ≤ 7 weeks versus patients with radiation &gt;7 weeks were: 93.2% versus 87.0% (P &lt; 0.001), 89.4% versus 84.4% (P = 0.016), 79.8% versus 70.6% (P &lt; 0.001) and 87.2% versus 78.4% (P &lt; 0.001), respectively.ConclusionsProlonged duration of radiotherapy with a significantly higher risk of distant metastasis and death in nasopharyngeal carcinoma patients. Understanding this point, healthcare providers should make efforts to avoid prolonged duration of radiotherapy to minimize the risk of treatment failure.

scholarly journals Prognostic Value of Circulating Lipoprotein in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

2018 ◽  
Vol 48 (1) ◽  
pp. 285-292
Author(s):  
Ji-Jin Yao ◽  
Xiao-Jun He ◽  
Wayne R. Lawrence ◽  
Wang-Jian Zhang ◽  
Jia Kou ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Prognostic Value ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Progression Free Survival ◽  
Rank Test ◽  
Significant Prognostic Factor ◽  
Roc Curve Analysis ◽  
Free Survival ◽  
Low Hdl

Background/Aims: Lipoproteins have been reported to be associated with prognosis in various cancers; however, the prognostic value of lipoproteins in patients with nasopharyngeal carcinoma (NPC) remains largely unknown. We aim to asses the role of circulating lipoproteins in locoregionally advanced NPC patients. Methods: Between October 2009 and August 2012, a total of 1,081 patients with stage III-IVB NPC were included in the analysis. Circulating high-density lipoprotein (HDL) and low-density lipoprotein (LDL) are the two key lipoproteins, which were measured at baseline. Receiver operating characteristic (ROC) curve analysis was used to evaluate different cut-off points for lipoproteins. Actuarial rates were performed using Kaplan–Meier methods and the log-rank test. Results: The cutoff points of HDL, LDL, and LDL/HDL ratio were 1.17 mmol/L, 3.75 mmol/L, and 2.73, respectively. At 5 years, high HDL (> 1.17 mmol/L) was significantly associated with better overall survival (OS, 86.6% vs. 78.9%; P=0.004), distant metastasis-free survival (DMFS, 86.9% vs. 80.8%; P=0.004), locoregional relapse-free survival (LRFS, 90.8% vs. 85.4%; P=0.010), and progression-free survival (PFS, 79.1% vs. 70.2%; P= 0.001) than low HDL (≤1.17 mmol/L). In contrast, high LDL (> 3.75 mmol/L) tend to be inferior OS (79.1% vs. 84.9%; P= 0.016) in compassion with low LDL (≤3.75 mmol/L). Likewise, patients with high LDL/HDL ratio (> 2.73) tend to be inferior OS (79.3% vs. 86.9%; P=0.001), DMFS (81.9% vs. 86.5%; P=0.030), and PFS (72.6% vs. 77.8%; P= 0.034) than those of low LDL/HDL ratio (≤2.73). In multivariate analysis, baseline HDL was found to be a significant prognostic factor for LRFS (HR= 0.65; 95% CI, 0.45-0.93; P= 0.019) and PFS (HR=0.75; 95% CI, 0.58-0.98; P= 0.034). Conclusions: Circulating HDL is significantly associated with treatment outcomes in patients with locoregionally advanced NPC. We suggest that HDL measurements will be of great clinical significance in the management of NPC.

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