Prognostic impact of adjuvant chemotherapy in high-risk nasopharyngeal carcinoma patients

•Adjuvant chemotherapy (AdjCT) reduced relapse in high-risk nasopharyngeal cancer patients.•AdjCT significantly improved both overall survival and progression-free survival.•The risk-features guided approaches are feasible during daily practice in all hospitals.

ObjectivesTo investigate the prognostic impact of adjuvant chemotherapy (AdjCT) in patients with high-risk nasopharyngeal carcinoma (NPC).Materials and methodsA total 403 NPC patients with at least one of the following criteria (1) neck node > 6 cm; (2) supraclavicular node metastasis; (3) skull base destruction/intracranial invasion plus multiple nodes metastasis; or (4) multiple neck nodes metastasis with one of nodal size > 4 cm were retrospectively reviewed. All patients finished curative radiotherapy ± neoadjuvant/concurrent chemotherapy. Post-radiation AdjCT consisted of tegafur-uracil (two capsules twice daily) for 12 months. We analyzed the treatment outcome between patients with (n = 154) and without (n = 249) AdjCT.ResultsBaseline patient characteristics at diagnosis (age, gender, pathological type, performance status, T-classification, N-classification, and overall stage) were comparable in both arms. After a median follow-up of 72 months for surviving patients, 31.8% (49/154) and 42.2% (105/249) in patients with and without AdjCT developed tumor relapse respectively (P = 0.0377). AdjCT improved both overall survival (HR 1.89, 95% CI 1.37-2.61, P = 0.0001) and progression-free survival (HR 1.42, 95% CI 1.03-1.96, P = 0.0322). There were significant reduction in distant failures (P = 0.0016) but not in local (P = 0.8587) or regional (P = 0.8997) recurrences for patients who received AdjCT.ConclusionAdjCT can reduce distant failure and improve overall survival in high-risk NPC patients after curative radiotherapy ± neoadjuvant/concurrent chemotherapy.