J Cancer 2019; 10(23):5614-5621. doi:10.7150/jca.35311

Research Paper

The impact of Adult Comorbidity Evaluation-27 on the clinical outcome of elderly nasopharyngeal carcinoma patients treated with chemoradiotherapy or radiotherapy: a matched cohort analysis

Yue-Feng Wen1,2,3*, Xue-Song Sun1,2*, Li Yuan1*, Li-Si Zeng4*, Shan-Shan Guo1,2, Li-Ting Liu1,2, Chao Lin1,2, Hao-Jun Xie1,2, Sai-Lan Liu1,2, Xiao-Yun Li1,2, Yi-Bin Zhang3, Wen-Jin Huang3, Hai-Hua Peng3, Zhi-Wei Liao3, Xian-Lu Song3, Qing-Nan Tang1,2, Yu-Jing Liang1,2, Jin-Jie Yan1,2, Jin-Hao Yang1,2, Zhen-Chong Yang1,2, Qiu-Yan Chen1,2, Xiao-Dan Lin3✉, Lin-Quan Tang1,2✉, Hai-Qiang Mai1,2✉

1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
2. Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P. R. China
3. Department of Radiotherapy, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou 510095, P. R. China
4. Cancer Research Institute, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou 510095, P. R.China
*Yue-Feng Wen, Xue-Song Sun, Li Yuan and Li-Si Zeng contributed equally to this work.

Abstract

Objectives: To evaluate the prognostic significance of Adult Comorbidity Evaluation-27 (ACE-27) for elderly patients (age ≥70 years) with locoregionally advanced nasopharyngeal carcinoma (NPC) treated with Intensity-Modulated Radiotherapy (IMRT), with or without chemotherapy.

Methods: 206 elderly patients with locoregionally advanced NPC treated from December 2006 to December 2016 were involved into analysis as the training cohort. Besides, a separate cohort of 72 patients from the same cancer center collected between January 2003 and October 2006 served as the validation cohort. By using propensity score matching (PSM), we created a balanced cohort by matching patients who received chemoradiotherapy with patients who received IMRT alone. Treatment toxicities were calculated between CRT and RT groups using the χ2 test. The primary endpoint was cancer-specific survival (CSS). Multivariate analysis was performed to assess the relative risk for each factor by using a Cox's proportional hazards regression model.

Results: The median follow-up was 39.0 months (range = 3-137 months). In the PSM cohort, patients in the CRT group achieved comparable survival compared with patients in the RT group. The 3-year CSS rate was 64.3% and 65.2%, respectively (P =0.764). In multivariate analysis, the addition of chemotherapy to IMRT was not an independent prognostic factor for CSS, whereas a high ACE-27 score was an independent risk factor. In subgroup analysis with ACE-27 score ≥ 2, the 3-year CSS rate was worse in patients from the CRT group (63.5% vs. 46.3%, P = 0.041).

Conclusions: CRT is comparable to IMRT alone for elderly patients with locoregionally advanced NPC. The ACE-27 tool may help to identify high-risk subgroup for poor disease outcome and tailor individualized treatment.

Keywords: Nasopharyngeal carcinoma, Elderly, Chemoradiotherapy, Intensity-modulated radiotherapy, Adult Comorbidity Evaluation-27

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How to cite this article:
Wen YF, Sun XS, Yuan L, Zeng LS, Guo SS, Liu LT, Lin C, Xie HJ, Liu SL, Li XY, Zhang YB, Huang WJ, Peng HH, Liao ZW, Song XL, Tang QN, Liang YJ, Yan JJ, Yang JH, Yang ZC, Chen QY, Lin XD, Tang LQ, Mai HQ. The impact of Adult Comorbidity Evaluation-27 on the clinical outcome of elderly nasopharyngeal carcinoma patients treated with chemoradiotherapy or radiotherapy: a matched cohort analysis. J Cancer 2019; 10(23):5614-5621. doi:10.7150/jca.35311. Available from http://www.jcancer.org/v10p5614.htm