Establishment and validation of M1 stage subdivisions for de novo metastatic nasopharyngeal carcinoma to better predict prognosis and guide treatment

Zou, Xiong; You, Rui; Liu, Huai; He, Yu; Xie, Guo Feng; Xie, Zhihai; Li, Ji Bin; Jiang, Rou; Liu, Li Zhi; Li, Li; Zhang, Meng Xia; Liu, You Ping; Hua, Yi; Guo, Ling; Qian, Chao Nan; Qiang, Hai; Chen, Dong Ping; Luo, Ying; Shen, Liang; Hong, Ming; Chen, Ming Yuan

doi:10.1016/j.ejca.2017.02.029

Cited by 95 publications

(111 citation statements)

References 32 publications

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“…It's reported that nearly 10% newly-diagnosed patients presented with synchronous distant metastasis (1,2) and approximately 20-30% patients developed metastasis after primary treatment (3)(4)(5). Bone metastasis (BM), especially axial bone, is the mostly frequently invaded organ with a proportion of over 50% (6)(7)(8) among all metastatic sites. Previous studies have shown diverse survival outcomes in this population with the median overall survival (OS) ranging from 20.3 to 36.9 months (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients

Jia

Sun

et al. 2020

Front. Oncol.

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Objective: To compare the survival outcomes brought by different radiation dose schedules to bone lesions and different chemotherapy regimens in bone metastatic nasopharyngeal carcinoma (NPC).Background: The current treatment strategy for bone metastatic NPC patients was empirically given and poorly studied before. It is of necessity to optimize the treatment for bone metastasis to enhance the therapeutic effect and increase the proportion of long-term survived patients.Methods: Three hundred patients who received chemoradiotherapy from 2002 to 2018 were involved in the study. Demographics, laboratory results, and detailed treatment plans were recorded. Radiotherapy plans were classified into three categories based on the intensity, and the survival analysis was performed using log-rank test. Multivariable analysis was made by the Cox proportional regression model. Results:Patients who received 60-75 Gy/30-35 fractions of radiation to the metastatic bones had significantly longer bone relapse-free survival (BRFS) (HR, 0.53, 95% CI, 0.37-0.78, P = 0.003), overall survival (OS) (HR, 0.63, 95% CI, 0.46-0.84, P = 0.007), and progression-free survival (PFS) (HR, 0.80, 95% CI, 0.67-0.95, P = 0.041). The administration of paclitaxel, cisplatin and 5-fluorouracil regimen was also associated with better BRFS (HR, 0.27, 95% CI, 0.10-0.75, P = 0.007), PFS (HR, 0.60, 95% CI, 0.42-0.87, P = 0.007), and OS with borderline significance (HR, 0.54, 95% CI, 0.29-1.03, P = 0.058). In multivariable analysis, the post-treatment EBV DNA level and radical radiation dose were proved as independent prognostic factors for both BRFS and OS.Conclusions: Radiotherapy to metastatic bones with palliative dose prescription should not be considered in bone metastatic NPC patients. TPF chemotherapy regimen might help to improve the survivals in NPC patients but failed to be an independent protective factor.

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Section: Introductionmentioning

confidence: 99%

Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients

Jia

Sun

et al. 2020

Front. Oncol.

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“…Hence, further subdivision of the M1 category for metastatic disease is of clinical importance for accurate prognosis prediction and personalized treatment planning. [9][10][11] De novo MBC is considered incurable but treatable. Generally, systemic therapy is viewed as the mainstay of treatment.…”

Section: Introductionmentioning

confidence: 99%

Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery

Lin

Ding

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Patients with de novo metastatic breast cancer (MBC) constitute a heterogeneous group with different clinicopathologic characteristics and survival outcomes. Despite controversy regarding its prognostic value, primary tumor surgery may improve survival for selected patients. Patients and Methods: Patients with de novo MBC were identified using the SEER database and were then divided randomly into training and validation sets. A Fine-Gray competing risks model was developed to identify the variables associated with increased cancer-specific mortality in the training set. The M1 subdivision system was established based on the independent prognostic factors. Cumulative incidence curves were estimated and compared using Gray’s test. Results: Involvement of brain or liver and number of metastatic sites were identified as independent prognostic factors in multivariate analysis. The M1 category was subdivided into 3 subcategories: M1a, single site involvement except brain and liver; M1b, liver involvement only, or multiple site involvement except brain and liver; and M1c, brain involvement regardless of number of metastatic sites, or liver and other sites involvement except brain (M1b vs M1a: subdistribution hazard ratio [SHR], 1.48; 95% CI, 1.29–1.68; M1c vs M1a: SHR, 2.45; 95% CI, 2.18–2.75). Patients with the M1a subtype benefited most from primary tumor surgery in the adjusted competing risks model (M1a: SHR, 0.57; 95% CI, 0.48–0.67, M1b: SHR, 0.62; 95% CI, 0.47–0.83, and M1c: SHR, 0.59; 95% CI, 0.44–0.80), whereas benefits conferred by treatment with chemotherapy alone increased with the upstaging of metastatic disease (M1a: SHR, 0.72; 95% CI, 0.62–0.83, M1b: SHR, 0.54; 95% CI, 0.44–0.68, and M1c: SHR, 0.53; 95% CI, 0.45–0.61). Conclusions: Subdivision of M1 stage facilitates prognosis prediction and treatment planning for patients with de novo MBC. Treatment offered should be decided in a coordinated multidisciplinary setting. Primary tumor surgery may play an important role in the management of selected patients.

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“…NPC tends to be especially aggressive in individuals who present with locoregionally advanced disease. The survival outcomes for NPC patients with distant metastases at diagnosis decreased significantly . Metastatic NPC (mNPC) remains an incurable disease and is treated by serial administration of cytotoxic or targeted therapies.…”

Section: Introductionmentioning

confidence: 99%

“…The survival outcomes for NPC patients with distant metastases at diagnosis decreased significantly. 3,4 Metastatic NPC (mNPC) remains an incurable disease and is treated by serial administration of cytotoxic or targeted therapies. The monitoring of treatment response is essential for avoiding the continuation of ineffective therapies with a poor outcome, preventing unnecessary side effects and determining the benefit of new therapeutics.…”

Section: Introductionmentioning

confidence: 99%

Relationship of circulating tumor cells and Epstein–Barr virus DNA to progression‐free survival and overall survival in metastatic nasopharyngeal carcinoma patients

You

Liu

Mei

et al. 2019

Intl Journal of Cancer

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We analyzed the number of circulating tumor cells (CTCs) and Epstein–Barr virus DNA (EBV DNA) for diagnosis, monitoring and prognosis of patients with metastatic nasopharyngeal carcinoma (mNPC). The levels of CTCs and EBV DNA were measured at baseline and after first‐line chemotherapy in 148 mNPC patients prospectively enrolled between December 2014 and August 2016. We also collected 122 non‐mNPC cases within the same time frame for examining CTCs and EBV DNA at baseline. In 270 NPC patients, we observed improved specificity (86.0% vs. 41.0%) and inferior sensitivity (42.3% vs. 81.3%) of CTCs as compared to EBV DNA for diagnosis of distant metastasis. mNPC patients were stratified into unfavorable and favorable prognostic groups, respectively, based on CTC of 12 at baseline and 1 after first‐line chemotherapy and EBV DNA of 10,000 at baseline and 4,000 after first‐line chemotherapy. Conversion of baseline unfavorable CTCs and EBV DNA to favorable after first‐line chemotherapy was associated with significantly longer progression‐free survival (PFS) and overall survival (OS) compared to patients with unfavorable CTCs and EBV DNA at both time points. Among patients with a complete/partial response as per imaging evaluation, favorable CTCs and EBV DNA levels after first‐line chemotherapy were associated with significantly longer PFS and OS. In conclusion, our data demonstrated the number of CTCs and EBV DNA before, after and during first‐line chemotherapy were strong predictive markers for mNPC patients. When utilized in conjunction with imaging studies, CTCs and EBV DNA could provide additional prognostic information.

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Establishment and validation of M1 stage subdivisions for de novo metastatic nasopharyngeal carcinoma to better predict prognosis and guide treatment

Cited by 95 publications

References 32 publications

Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients

Intensive Local Radiotherapy Is Associated With Better Local Control and Prolonged Survival in Bone-Metastatic Nasopharyngeal Carcinoma Patients

Subdivision of M1 Stage for De Novo Metastatic Breast Cancer to Better Predict Prognosis and Response to Primary Tumor Surgery

Relationship of circulating tumor cells and Epstein–Barr virus DNA to progression‐free survival and overall survival in metastatic nasopharyngeal carcinoma patients

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