Ten-year survival outcomes of concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma in the IMRT era: A retrospective cohort study stratified by high- and low-risk profiles

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Objective: To evaluate 10-year survival outcomes of intensity-modulated radiotherapy (IMRT)-era locoregionally advanced nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT) ± adjuvant chemotherapy (AC), and assess the impact of AC on survival in high-risk and low-risk patients. Methods: This retrospective cohort study analyzed 477 non-metastatic NPC patients (2009-2012) treated with CCRT + AC (n = 315) or CCRT alone (n = 162). Risk stratification into high-/low-risk subgroups utilized a published prognostic model. Kaplan-Meier estimates compared 10-year overall survival (OS), locoregional failure-free survival (LFFS), distant metastasis-free survival (DMFS), and failure-free survival (FFS). Results: The 10-year OS, DMFS, LFFS, and FFS rates for the entire cohort were 71.7 %, 81.4 %, 87.9 %, and 68.1 %, respectively. Compared to CCRT alone, CCRT + AC demonstrated no significant improvement in OS (70.9 % vs. 73.4 %; HR = 1.036, 95 % CI: 0.717-1.497, P = 0.849), LFFS (87.5 % vs. 88.7 %; HR = 1.176, 95 % CI: 0.642-2.154, P = 0.598), DMFS (79.4 % vs. 85.3 %; HR = 1.356, 95 % CI: 0.839-2.191, P = 0.211), or FFS (66.4 % vs. 71.5 %; HR = 1.133, 95 % CI: 0.803-1.599, P = 0.477). In high-risk patients, AC failed to enhance OS (62.7 % vs. 57.5 %; HR = 0.755, 95 % CI: 0.511-1.115, P = 0.156) or other survival endpoints. Notably, AC was associated with reduced OS (84.8 % vs. 94.1 %; HR = 3.319, 95 % CI: 0.966-11.401, P = 0.043) and FFS (77.8 % vs. 92.0 %; HR = 2.596, 95 % CI: 1.064-6.332, P = 0.029) in low-risk patients, while showing no benefit in LFFS or DMFS. Conclusion: The addition of AC to CCRT did not improve 10-year survival outcomes in locoregionally advanced NPC. Moreover, AC may adversely impact survival in low-risk patients, highlighting the need for risk-adapted therapeutic strategies.

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