The significant survival advantage of female sex in nasopharyngeal carcinoma: a propensity-matched analysis.

BACKGROUND: Whether females have better survival than males in nasopharyngeal carcinoma is barely acknowledged and the exact explanations remain unknown. METHODS: Overall, 5929 patients receiving treatment between January 2005 and December 2010 were separately stratified by stage into early and advanced stage groups, and by age into premenopausal (⩽45 years), menopausal (46-54 years) and postmenopausal (⩾55 years) groups. Matched males and females in each group were identified using the propensity score matching method. Differences in disease-free survival (DSS), overall survival (OS), distant metastasis-free survival (DMFS) and locoregional relapse-free survival (LRFS) were estimated by the Kaplan-Meier method and Cox regression model. RESULTS: Overall, 398, 923, 744, 319 and 313 pairs of males and females were matched in early stage, advanced stage, premenopausal, menopausal and postmenopausal group, respectively. Females showed significant advantage over males across all end points in both early and advanced stage groups (P⩽0.042). However, this advantage persisted at premenopausal age (P⩽0.042), declined during menopause (DMFS, P=0.021; DSS, P=0.100; OS, P=0.693; LRFS, P=0.330) and totally disappeared at postmenopausal age (P⩾0.344). CONCLUSIONS: Sex significantly affects NPC survival, with a definite female advantage regardless of tumour stage. Intrinsic biologic traits appear to be the exact explanation according to the declining magnitude of sex effect with age.

Comparison of TNM staging systems for nasopharyngeal carcinoma, and proposal of a new staging system.

BACKGROUND: There are few systematic evaluations regarding the sixth and seventh editions of the UICC/AJCC TNM Staging System (TNM6th, TNM7th) and Chinese 2008 Staging System (TNMc2008) for nasopharyngeal carcinoma (NPC). METHODS: We classified 2333 patients into intensity-modulated radiotherapy (IMRT) cohort (n=941) and conventional radiotherapy (CRT) cohort (n=1392). Tumour staging defined by TNM6th, TNM7th and TNMc2008 was compared based on Akaike information criterion (AIC) and Harrell's concordance index (c-index). RESULTS: For T-classification, TNM6th (AIC=2585.367; c-index=0.6390385) had superior prognostic value to TNM7th (AIC=2593.242; c-index=0.6226889) and TNMc2008 (AIC=2593.998; c-index=0.6237146) in the IMRT cohort, whereas TNMc2008 was superior (AIC=5999.054; c-index=0.623547) in the CRT cohort. For N-classification, TNMc2008 had the highest prognostic value in both cohorts (AIC=2577.726, c-index=0.6297874; AIC=5956.339, c-index=0.6533576). Similar results were obtained when patients were stratified by chemotherapy types, age and gender. Using staging models in the IMRT cohort, we failed to identify better stage migrations than TNM6th T-classification and TNMc2008 N-classification. We therefore proposed to combine these categories; resultantly, stage groups of the proposed staging system showed superior prognostic value over TNM6th, TNM7th and TNMc2008. CONCLUSION: TNM6th T-classification and TNMc2008 N-classification have superior prognostic value in the IMRT era. By combining them with slight modifications, TNM criteria can be unified and its prognostic value be improved.

Prognostic value of ABO blood group in southern Chinese patients with established nasopharyngeal carcinoma.

BACKGROUND: ABO blood group is associated with aetiology of nasopharyngeal carcinoma (NPC); however, the effect of it on survival of patients diagnosed with NPC has not been explored. METHODS: We retrospectively analysed two cohorts of southern Chinese patients with WHO histological type III: intensity-modulated radiotherapy (IMRT) cohort, 924 patients; and conventional radiotherapy (CRT) cohort, 1193 patients. Associations of ABO blood group with survival were estimated using Cox regression. RESULTS: In IMRT cohort, we observed significant associations of blood type A with overall survival (OS) and distant metastasis-free survival (DMFS), compared with type O, after adjusting for prognostic factors. Compared with non-A blood types (B, AB, and O), type A patients had significantly lower OS and DMFS (adjusted hazard ratio (HR)=1.49, 95% CI 1.03-2.17, P=0.036; HR=1.68, 95% CI 1.13-2.51, P=0.011, respectively); similar results were obtained in CRT cohort. Subgroup analyses of the entire population showed that lower OS conferred by blood type A was not significantly modified by age, smoking status, drinking status, immunoglobulin A against Epstein-Barr virus viral capsid antigen (VCA-IgA) titre, or chemotherapy; however, lower OS was not observed in female patients or patients with early clinical stage disease. CONCLUSION: ABO blood group is associated with survival in NPC; patients with blood type A had significantly lower OS and DMFS than patients with non-A blood types.

Prognostic impact of family history in southern Chinese patients with undifferentiated nasopharyngeal carcinoma.

BACKGROUND: Family history of cancer is associated with developing nasopharyngeal carcinoma (NPC); however, the impact of it on survival among established NPC patients remains unknown. METHODS: We retrospectively analysed 1773 southern Chinese patients. Associations between a first-degree family history of NPC and overall survival (OS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) were estimated by Cox regression. RESULTS: Among 1773 patients, 207 (11.7%) reported a first-degree family history of NPC. Compared with patients without a family history, the adjusted hazard ratios among those with it were 0.60 (95% confidence interval (CI), 0.37-0.98; P=0.040) for OS, 0.52 (95% CI, 0.24-1.12; P=0.096) for LRFS and 0.51 (95% CI, 0.27-0.97; P=0.040) for DMFS. There were trends for improving OS, LRFS and DMFS with increasing number of affected relatives (Ptrend: 0.050, 0.114 and 0.044, respectively). But no significant benefits of family history in second- or third-degree relatives were observed. In subgroup analysis, we observed the effects of family history with restriction to male patients and those of advanced stage and treated with conventional radiotherapy and addition of chemotherapy. CONCLUSION: A first-degree family history of NPC is associated with improved survival of patients.

Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials.

BACKGROUND: We carried out this meta-analysis to demonstrate efficacies of neoadjuvant chemotherapy (NACT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC) patients based on randomized, controlled trials (RCTs). PATIENTS AND METHODS: We comprehensively searched electronic databases and manuscripts for RCTs and extracted data from eligible studies for meta-analysis. Overall survival (OS) with hazard ratios (HRs), locoregional recurrence rate (LRR) and distant metastasis rate (DMR) with relative risks (RRs) were concerned using random and/or fixed-effects models. Subgroup and sensitivity analyses were also carried out. RESULTS: Six trials in NACT group (n = 1418) and five in AC group (n = 1187) were eligible. HR of death for NACT was 0.82 [95% confidence interval (CI) 0.69-0.98, P = 0.03], corresponding to an absolute survival gain of 5.13% after 3 years. Significant reduction of DMR (P = 0.0002; RR 0.69, 95% CI 0.56-0.84) was also found from NACT. But no decrease in LRR (P = 0.49; RR 0.90, 95% CI 0.66-1.22) was observed. Patients receiving additional AC had lower LRR (P = 0.03; RR 0.71, 95% CI 0.53-0.96). But no benefit of OS and DMR were seen in AC. CONCLUSIONS: NACT can effectively enhance OS and reduce DMR, not LRR in NPC. And AC only helps to better control locoregional recurrence of NPC.

Reversible ferromagnetism study in un-doped ZnO thin films.

Room temperature ferromagnetism in pure ZnO thin films prepared by spin-coating method was observed. X-ray photoelectron spectroscopy and inductively coupled plasma-mass spectrometry showed no or extremely little presence of impurities, which were unlikely to be responsible for the large magnetization moment observed. In order to study the origin of ferromagnetism, ZnO thin films were rapidly annealed in N2 and O2 ambient in a repetitive way. Electrical and magnetic performance after each annealing was measured. It is found that ferromagnetism is diminished and re-appeared, in accordance with the decrease and increase of conductivity. Cathodoluminescence spectra show evidence of reversible variation of oxygen vacancy defect in the annealing process. These results provide strong evidence that oxygen vacancies play a significant role in inducing ferromagnetism in ZnO thin films.

[Observation on effect of radiotherapy and antike capsule combination therapy in treating nasopharyngeal cancer patients].

OBJECTIVE: To compare the effect of radiotherapy (RT) combined with Antike capsule (AC) and RT alone in treating nasopharyngeal cancer (NPC) patients. METHODS: Eighty-nine patients with pathologically confirmed NPC (stage II-IV) were randomly divided into two groups: group A (46 cases) were treated with RT, receiving 65-70 Gy/6.5-7 weeks to nasopharynx region and the same dosage to neck region, and AC was given in combination. Group B (43 cases) received the same RT alone. The total dosis of RT for complete remission (CR) of primary nasopharyngeal tumor and neck lymph nodes, the CR rate and the changes of peripheral NK cell, T lymphocyte subsets in the two groups were compared. RESULTS: The total dosis of RT for CR in group A and B were 41.6 +/- 8.9 Gy vs 50.7 +/- 9.2 Gy for primary nasopharyngeal tumor, P < 0.05 and 47.4 +/- 10.3 Gy vs 56.2 +/- 9.7 Gy for neck lymph nodes, P < 0.05. The CR rate of primary nasopharyngeal tumor in group A and B were 93.5% and 88.4% respectively, P < 0.05. The activity of NK cell as well as T3, T4 in peripheral blood increased significantly in the group A after treatment, P < 0.05, while in group B, T3, T4 lowered significantly, P < 0.05. CONCLUSION: RT combined with AC could be helpful in elevating and promoting the remission rate of primary tumor and neck lymph nodes, and AC has some effects in improving the immune function and general condition in NPC patients during RT.

[Clinical observation on nasopharyngeal carcinoma treated with combined therapy of radiotherapy and ginseng polysaccharide injection].

OBJECTIVE: To observe the effect of radiotherapy (RT) combined with Ginseng polysaccharide (GSP) injection in treating nasopharyngeal carcinoma (NPC) and its influence on immune function. METHODS: One hundred and thirty-one NPC patients were randomly divided into two groups, 64 cases in the RT-GSP group treated with RT-GSP and 67 in the control group treated with conventional therapy, to observe the local cancer remission rate, 1-year total survival rate, no tumor survival rate and no remote metastasis survival rate. Moreover, the changes of T-lymphocyte subsets, natural killer (NK) cell activity and lymphocyte activated killer (LAK) cell activity before and after treatment were observed. RESULTS: Clinical examination conducted 3 months after treatment showed that the complete remission rete in the RT-GSP group was 96.6%, and in the control group 93.3%, the complete remission rate of cervical node metastatic tumor in the two groups was 85.7% and 78.0% respectively, and the NPC CT remission rate 60.3% and 51.7% respectively. Re-examination carried out 1 year after RT treatment showed that the total survival rate in the two groups was 100% and 96.5%, no tumor survival rate 84.4% and 74.6%, and no remote metastasis survival rate was 93.8% and 88.1% respectively. The activity of NK cell and LAK cell as well as T3, T4 value in peripheral blood increased significantly in the RT-GSP group (all P < 0.05) after treatment, while in the control group, activity of NK cell and LAK cell changed insignificantly after treatment, and T3, T4 value lowered significantly (P < 0.05). No toxic-adverse reaction of GSP was found. CONCLUSION: GSP has certain improving immune function effect in NPC patients during RT, it could also eliminate the occurred adverse reaction to RT and the general condition of patients.