Implication of comorbidity on the initiation of chemotherapy and survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma

Guo, Rui; Mao, Yan Ping; Chen, Lei; TANG, Ling; Zhou, Guan Qun; Liu, Li Zhi; Liu, Tian; Zeng, Mu Sheng; Jia, Wei Hua; Shao, Jian Yong; Lin, Ai Hua; Ma, Jun

doi:10.18632/oncotarget.8621

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…In this study of elderly patients with NPC receiving definitive RT, we found that, when using the CCI score as a measure of medical comorbidities, significant comorbidities were present in 22.4% of patients. Previous studies have reported the incidence of comorbidity in patients with NPC to be 40.2–58% . Ramakrishnan et al.…”

Section: Discussionmentioning

confidence: 99%

The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis

et al. 2018

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The number of elderly patients with cancer is increasing. Medical comorbidities are more common in this population. Little is known regarding the prognostic relevance of comorbidities in elderly patients with nasopharyngeal carcinoma (NPC). Using the National Cancer Data Base (NCDB), we queried patients age >65 years diagnosed with NPC and treated with definitive radiation between 2004 and 2012 to examine the association between comorbidity and survival outcomes. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). The influence of comorbidity on overall survival (OS) was evaluated. Cox proportional hazards model was used to study the impact of comorbidity on OS. A total of 1137 patients met the specified criteria. Median follow‐up was 61.2 months. Five‐year OS was 50.4%. Comorbidities were present in 22.4% of patients, with 17.6% of patients having a CCI score of 1% and 4.8% having a CCI score of ≥2. Patients with a CCI score of 0 had significantly higher 5‐year OS than patients with a CCI score of 1 or ≥2 (53.1% vs. 42.2% vs. 32.9%, P < 0.001). In multivariate analysis, CCI was a statistically significant independent prognostic factor for the risk of death of all causes for patients with a CCI score of 1 (hazard ratio [HR]: 1.242; 95% confidence interval [CI]: 1.002–1.539) or CCI score of ≥2 (HR: 1.625; 95% CI: 1.157–2.283) when compared to patients with a CCI score of 0. Comorbidity as measured by CCI is a strong independent prognostic factor for OS in elderly patients with NPC and lends support to the inclusion of comorbidity assessment due to its prognostic value when treating elderly patients with NPC.

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Section: Discussionmentioning

confidence: 99%

The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis

et al. 2018

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“…In this study, comorbidity was present in 40.1% of patients. The incidence of comorbidity in lrNPC patients is similar to that in primary NPC patients ( 17 ). However, patients with moderate and severe comorbidities were observed to have higher rates of comorbidity than primary NPC.…”

Section: Discussionmentioning

confidence: 61%

Development of a Comorbidity-Based Nomogram to Predict Survival After Salvage Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era

et al. 2021

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PurposeTo assess the impact of comorbidity on treatment outcomes in patients with locally recurrent nasopharyngeal carcinoma (lrNPC) using intensity-modulated radiotherapy (IMRT) and to develop a nomogram that combines prognostic factors to predict clinical outcome and guide individual treatment.MethodsThis was a retrospective analysis of patients with lrNPC who were reirradiated with IMRT between 2003 and 2014. Comorbidity was evaluated by Adult Comorbidity Evaluation-27 grading (ACE-27). The significant prognostic factors (P < 0.05) by multivariate analysis using the Cox regression model were adopted into the nomogram model. Harrell concordance index (C-index) calibration curves were applied to assess this model.ResultsBetween 2003 and 2014, 469 lrNPC patients treated in our institution were enrolled. Significant comorbidity (moderate or severe grade) was present in 17.1% of patients by ACE-27. Patients with no or mild comorbidity had a 5-year overall survival (OS) rate of 36.2 versus 20.0% among those with comorbidity of moderate or severe grade (P < 0.0001). The chemotherapy used was not significantly different in patients with lrNPC (P > 0.05). For the rT3–4 patients, the 5-year OS rate in the chemotherapy + radiation therapy (RT) group was 30.0 versus 16.7% for RT only (P = 0.005). The rT3–4 patients with no or mild comorbidity were associated with a higher 5-year OS rate in the chemotherapy + RT group than in the RT only group (32.1 and 17.1%, respectively; P=0.003). However, for the rT3–4 patients with a comorbidity (moderate or severe grade), the 5-year OS rate in the chemotherapy + RT group vs. RT alone was not significantly different (15.7 vs. 15.0%, respectively; p > 0.05). Eight independent prognostic factors identified from multivariable analysis were fitted into a nomogram, including comorbidity. The C-index of the nomogram was 0.715. The area under curves (AUCs) for the prediction of 1-, 3-, and 5-year overall survival were 0.770, 0.764, and 0.780, respectively.ConclusionComorbidity is among eight important prognostic factors for patients undergoing reirradiation. We developed a nomogram for lrNPC patients to predict the probability of death after reirradiation and guide individualized management.

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“…Next, the incidence of comorbidities significantly increased with age in this sort of cancer [20]. Patients with comorbidities were more likely to experience undertreatment, and comorbidity itself indicated poor prognosis in locoregionally advanced NPC [20]. Besides, older patients were found to be those had higher titer of VCA-IgA and EA-IgA and diagnosed with more advanced clinical stage (Table 1).…”

Section: Discussionmentioning

confidence: 94%

“…Considering the inferior outcome of concurrent chemotherapy with cisplatin below 200 mg/m 2 [19], older patients possibly achieved poor survival. Next, the incidence of comorbidities significantly increased with age in this sort of cancer [20]. Patients with comorbidities were more likely to experience undertreatment, and comorbidity itself indicated poor prognosis in locoregionally advanced NPC [20].…”

Section: Discussionmentioning

confidence: 94%

Age at diagnosis indicated poor prognosis in locoregionally advanced nasopharyngeal carcinoma

Zhang¹,

Qiu²,

OuYang³

et al. 2016

Oncotarget

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Implication of comorbidity on the initiation of chemotherapy and survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma

Cited by 8 publications

References 22 publications

The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis

The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis

Development of a Comorbidity-Based Nomogram to Predict Survival After Salvage Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era

Age at diagnosis indicated poor prognosis in locoregionally advanced nasopharyngeal carcinoma

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