Risk Stratification and Individualized Chemotherapy for Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

Abstract Backgroud: The optimal treatment strategy for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains unclear. We aimed to develop individualized treatment strategies for such patients according to their pretreatment risk stratification and the degree of comorbidities. Methods: A total of 583 elderly LA-NPC patients diagnosed between January 2011 and January 2018 were retrospectively studied. Based on prognostic factors confirmed by multivariate analysis, we constructed a nomogram for disease-free survival (DFS). The entire cohort was then divided into two groups according to the nomogram cutoff value determined by X-tile analysis. The degree of comorbidities was assessed by Charlson Comorbidity Index (CCI). We performed subgroup analysis based on the degree of complications in the low- and high-risk groups to compare the survival outcomes of different treatment regimens using the Kaplan-Meier method and the log-rank test. Results: A nomogram for DFS was constructed with T/N classification, Epstein-Barr virus DNA and albumin. The high-risk group had significantly poorer survival compared with the low-risk group. The 3-year DFS and overall survival (OS) of the low-risk group and the high-risk group were 76.7% vs. 44.6%, 81.5% vs. 51.0% (both P <0.001) respectively. Only high-risk patients with fewer comorbidities (CCI =2) would benefit from induction chemotherapy combined with concurrent chemoradiotherapy, while patients in the low-risk group or the high-risk group with more comorbidities (CCI >2) would not have. Conclusion: We constructed a prognostic nomogram for DFS and generated two risk groups. Combining risk stratification and degree of comorbidities can better guide individualized treatment for elderly LA-NPC patients.