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. 2025 Jun 27:54:101006.
doi: 10.1016/j.ctro.2025.101006. eCollection 2025 Sep.

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

Wang-Jian Li  1 , Li-Ting Ling  1 , Yue Yao  1 , Kai-Qing Tan  1 , Bo-Lin Zhu  1 , Li-Qing Zhou  1 , Song Qu  1 , Ling Li  1 , Ying Guan  1 , Ling-Hui Pan  2   3   4 , Xiao-Dong Zhu  1 , Zhong-Guo Liang  1
Affiliations

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

Wang-Jian Li et al. Clin Transl Radiat Oncol. .

Abstract

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.

Keywords: Adjuvant chemotherapy; Concurrent chemoradiotherapy; Long-term survival; Nasopharyngeal carcinoma; Risk stratification.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Overall survival (A), locoregional failure-free survival (B), distant metastasis-free survival (C), and failure-free survival (D) in patients with locoregionally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone.
Fig. 2
Fig. 2
Subgroup analyses of overall survival (A), failure-free survival (B), distant metastasis-free survival (C), and locoregional failure-free survival (D) in locoregionally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone.
Fig. 3
Fig. 3
Comparison of overall survival (A), locoregional failure-free survival (B), distant metastasis-free survival (C), and failure-free survival (D) between high-risk and low-risk subgroups in patients with locoregionally advanced nasopharyngeal carcinoma.
Fig. 4
Fig. 4
Overall survival (A, C) and failure-free survival (B, D) in low-risk locoregionally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone. (A, B: Pre-matching cohort; C, D: Post-matching cohort analysis).
Fig. 5
Fig. 5
Overall survival (A, C) and failure-free survival (B, D) in high-risk locoregionally advanced nasopharyngeal carcinoma treated with concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone. (A, B: Pre-matching cohort; C, D: Post-matching cohort analysis).
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