The Prognostic Value Of Plasma Uric Acid And Tumor Response To Induction Chemotherapy In Locally Advanced Nasopharyngeal Carcinoma

At present, tumor response to induction chemotherapy (IC) was reported to be an independent prognostic factor for advanced-stage nasopharyngeal carcinoma (NPC). However, the combined predictive value of plasma uric acid and tumor response to IC in locally advanced nasopharyngeal carcinoma (LANPC) patients receiving IC followed by concurrent chemoradiation therapy (CCRT) remains largely unknown. In all, 341 consecutive patients with NPC treated with IC+CCRT were retrospectively enrolled. All patients received pre- and post-induction chemotherapy magnetic resonance image (MRI). The plasma uric acid level and tumor response were recorded after two cycles of IC. Tumor response were evaluated using MRI images after 2 cycles of IC based on Response Evaluation Criteria in Solid Tumors (RECIST).Overall (OS), progression-free (PFS), locoregional relapse-free survival (LRFS) and distant metastasis-free (DMFS) survival were compared using Kaplan-Meier analysis and the log rank test, and Cox multivariate were created. Patients with a high plasma uric acid level after 2 cycles of IC (>327 μmol/L) had a better OS, PFS, and DMFS than patients with a low plasma uric acid level (all P < 0.05). Patients with an unsatisfactory tumor response (stable disease or disease progression) to IC had an unfavorable OS, PFS, and DMFS than patients with a satisfactory tumor response (complete response or partial response) to IC (all P< 0.05). Multivariate analysis showed that the plasma uric acid level after 2 cycles of IC was an independent prognostic factor for OS (P = 0.012), and of borderline significance for PFS and DMFS (P = 0.055 and P = 0.067, respectively). In addition, tumor response to IC was found to an independent prognostic factor for OS, PFS, and DMFS (all P< 0.05), respectively. Finally, patients with CR/PR and high plasma uric acid level after 2 cycles of IC had a better DMFS, PFS and OS compared to patients with SD/PD and low plasma uric acid level after 2 cycles of IC (all P< 0.05). The plasma uric acid level and the tumor response to 2 cycles of IC have predictive value for locally advanced NPC patients treated with IC followed by CCRT. More aggressive therapeutic strategies are recommended for LANPC patients with low plasma uric acid level and SD/PD to 2 cycles of IC.