Abstract：
BACKGROUND: This retrospective study aimed to determine the optimal metronomic chemotherapy duration (MTCD) as adjuvant therapy for patients with locally advanced nasopharyngeal carcinoma (LANPC).
METHODS: This study involved LANPC patients treated with metronomic chemotherapy (MTC) using a 5-FU prodrug (S1, capecitabine, or tegafur) from May 2013 to September 2020. The optimal MTCD threshold was established using X-tile Bioinformatics software. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were compared between short-term and long-term groups using propensity score matching (PSM).
RESULTS: A total of 546 patients were analyzed. MTCD was an independent prognostic factor for OS, PFS, and DMFS (all P < 0.05). Patients were categorized into long-term (>3 months) and short-term (≤3 months) MTCD groups. After a median follow-up of 48 months, significant differences were observed in 4-year OS (97.0 % vs. 87.1 %; P < 0.01), PFS (84.6 % vs. 70.9 %; P < 0.01), DMFS (87.3 % vs. 78.8 %; P < 0.01), and LRRFS (95.3 % vs. 87.4 %; P < 0.01) between the long-term and short-term groups. In the PSM-matched cohort of 196 patients per group, the long-term group demonstrated superior 4-year OS and LRRFS (97.3 % vs. 87.1 %, P < 0.01; 95.2 % vs. 90.0 %, P < 0.05). No significant differences in acute toxicities were observed between the groups (P > 0.05).
CONCLUSIONS: Extended MTC with a 5-FU prodrug (>3 months) may benefit NPC patients. Further prospective studies are needed to validate these findings.
METHODS: This study involved LANPC patients treated with metronomic chemotherapy (MTC) using a 5-FU prodrug (S1, capecitabine, or tegafur) from May 2013 to September 2020. The optimal MTCD threshold was established using X-tile Bioinformatics software. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were compared between short-term and long-term groups using propensity score matching (PSM).
RESULTS: A total of 546 patients were analyzed. MTCD was an independent prognostic factor for OS, PFS, and DMFS (all P < 0.05). Patients were categorized into long-term (>3 months) and short-term (≤3 months) MTCD groups. After a median follow-up of 48 months, significant differences were observed in 4-year OS (97.0 % vs. 87.1 %; P < 0.01), PFS (84.6 % vs. 70.9 %; P < 0.01), DMFS (87.3 % vs. 78.8 %; P < 0.01), and LRRFS (95.3 % vs. 87.4 %; P < 0.01) between the long-term and short-term groups. In the PSM-matched cohort of 196 patients per group, the long-term group demonstrated superior 4-year OS and LRRFS (97.3 % vs. 87.1 %, P < 0.01; 95.2 % vs. 90.0 %, P < 0.05). No significant differences in acute toxicities were observed between the groups (P > 0.05).
CONCLUSIONS: Extended MTC with a 5-FU prodrug (>3 months) may benefit NPC patients. Further prospective studies are needed to validate these findings.
摘要：
背景：这项回顾性研究旨在确定局部晚期鼻咽癌（LANPC）患者的最佳节拍化疗持续时间（MTCD）作为辅助治疗。
方法：本研究涉及使用5-FU前药（S1，卡培他滨，或tegafur)从2013年5月到2020年9月。使用X-tile生物信息学软件建立最佳MTCD阈值。总生存期（OS），无进展生存期（PFS），无远处转移生存期（DMFS），使用倾向评分匹配(PSM)比较短期组和长期组之间的局部无复发生存率(LRRFS).
结果：共分析546例患者。MTCD是OS的独立预后因素，PFS,DMFS(均P<0.05)。患者分为长期（>3个月）和短期（≤3个月）MTCD组。在中位随访48个月后，在4年OS中观察到显著差异(97.0%与87.1%;P<0.01),PFS（84.6%vs.70.9%；P<0.01），DMFS（87.3%与78.8%;P<0.01),和LRFS（95.3%与87.4%；长期组与短期组之间P<0.01)。在每组196名患者的PSM匹配队列中，长期组表现出优于4年OS和LRRFS(97.3%vs.87.1%,P<0.01;95.2%vs.90.0%,P<0.05)。两组急性毒性差异无统计学意义(P>0.05)。
结论：使用5-FU前药的延长MTC（>3个月）可能使NPC患者受益。需要进一步的前瞻性研究来验证这些发现。
方法：本研究涉及使用5-FU前药（S1，卡培他滨，或tegafur)从2013年5月到2020年9月。使用X-tile生物信息学软件建立最佳MTCD阈值。总生存期（OS），无进展生存期（PFS），无远处转移生存期（DMFS），使用倾向评分匹配(PSM)比较短期组和长期组之间的局部无复发生存率(LRRFS).
结果：共分析546例患者。MTCD是OS的独立预后因素，PFS,DMFS(均P<0.05)。患者分为长期（>3个月）和短期（≤3个月）MTCD组。在中位随访48个月后，在4年OS中观察到显著差异(97.0%与87.1%;P<0.01),PFS（84.6%vs.70.9%；P<0.01），DMFS（87.3%与78.8%;P<0.01),和LRFS（95.3%与87.4%；长期组与短期组之间P<0.01)。在每组196名患者的PSM匹配队列中，长期组表现出优于4年OS和LRRFS(97.3%vs.87.1%,P<0.01;95.2%vs.90.0%,P<0.05)。两组急性毒性差异无统计学意义(P>0.05)。
结论：使用5-FU前药的延长MTC（>3个月）可能使NPC患者受益。需要进一步的前瞻性研究来验证这些发现。
