Docetaxel and cisplatin induction chemotherapy with or without fluorouracil in locoregionally advanced nasopharyngeal carcinoma: A retrospective propensity score matching analysis

Abstract

Purpose: To investigate whether the addition of fluorouracil to docetaxel and cisplatin induction chemotherapy (IC) can truly improve the prognosis of patients with locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods: A total of 801 patients newly diagnosed with non-metastatic locoregionally advanced NPC were included as the subjects. In this study, propensity score matching (PSM) was used for analysis of overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and locoregional relapse-free survival (LRRFS), and the chi-squared test or Fisher's exact test was used to investigate toxic reactions.

Results: Patients received treatment with docetaxel and cisplatin (TP) or docetaxel, cisplatin and fluorouracil (TPF). With a median follow-up time of 60 months (range: 5-124 months), the TPF group had better 5-year OS (84.7% vs 79.0%; P = 0.037), PFS (84.6% vs 76.8%; P = 0.008) and DMFS (89.5% vs 82.3%; P = 0.004) than the TP group. After PSM, 258 patients were matched in each cohort. The Kaplan-Meier analysis showed that the 5-year OS, PFS and DMFS were 85.5%, 84.2% and 89.2%, respectively, in the TPF group, higher than the 80.8%, 75.0% and 81.4%, respectively, in the TP group (P = 0.048, 0.009 and 0.006, respectively). Moreover, the multivariate analysis revealed that different IC regimens were independent prognostic factors for PFS and DMFS (P = 0.014 and 0.010, respectively).

Conclusion: This study found that compared with the TP regimen, TPF induction chemotherapy is associated with improved survival in patients with locoregionally advanced NPC. TPF can produce more mucosal and nausea/vomiting adverse reactions than TP.

Keywords: fluorouracil; induction chemotherapy; nasopharyngeal carcinoma; propensity score-matching.

FIGURE 1

Flow diagram. IC, induction chemotherapy; CCRT, concurrent chemoradiotherapy; TP, cisplatin and docetaxel; TPF, docetaxel, cisplatin and fluorouracil

FIGURE 2

Kaplan–Meier survival curves based on the IC regimens of docetaxel and cisplatin (TP) versus docetaxel, cisplatin and fluorouracil (TPF) for the entire cohort. (a) Overall survival; (b) progression‐free survival; (c) distant metastasis‐free survival and (d) locoregional relapse‐free survival [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Kaplan–Meier survival curves based on the IC regimens of docetaxel and cisplatin (TP) versus docetaxel, cisplatin and fluorouracil (TPF) for the propensity‐matched cohort. (a) Overall survival; (b) progression‐free survival; (c) distant metastasis‐free survival and (d) Locoregional relapse‐free survival [Colour figure can be viewed at wileyonlinelibrary.com]