Using real-world evidence, this study aimed to identify elderly nasopharyngeal carcinoma (NPC) patients who would benefit from chemotherapy. 1714 elderly NPC patients between April 2007 and December 2017 were identified. Recursive partitioning analysis (RPA) was used to generate risk-stratified outcomes. Prognostic factors were performed for individual comparisons of different risk groups to assess chemotherapy benefits. The median follow-up was 59.3 (0.39–170.09) months. Epstein Barr virus (EBV) DNA and T stage were included in the RPA-generated risk stratification, categorizing patients into a good-prognosis group (EBV DNA ≤ 4000 copies/mL & T1–2), and a poor-prognosis group (EBV DNA ≤ 4000 copies/mL & T3–4 and EBV DNA > 4000 copies/mL & any T). Overall survival (OS) was significantly higher in the good-prognosis group compared with the training set (HR = 0.309, 95% CI 0.184–0.517; P < 0.001), and validated in the testing set (HR = 0.276, 95% CI 0.113–0.670; P = 0.002). In the poor-prognosis group, a significantly improved OS for chemoradiotherapy (CRT) compared with RT alone was observed (HR = 0.70, 95% CI 0.55–0.88; P = 0.003). Patients who received induction chemotherapy (IC) + concurrent chemoradiotherapy (CCRT) and CCRT had a significantly improved OS compared with RT alone (IC + CCRT vs. RT alone: P = 0.002; CCRT vs. RT alone: P = 0.008) but not in the IC + RT group (P = 0.306). The 5-year OS for CRT versus RT-alone with ACE-27 scores of 0, 1 and 2 were 76.0% versus 70.0% (P = 0.014), 80.5% versus 68.2% (P = 0.150) and 58.5% versus 62.2% (P = 0.490), respectively; for those aged 60–64, 65–70 and ≥ 70 years old they were 80.9% versus 75.9% (P = 0.068), 73.3% versus 63.4% (P = 0.270) and 64.8% versus 67.1% (P = 0.820), respectively. For elderly NPC patients a simple screening cutoff for chemotherapy beneficiaries might be EBV DNA < 4000 copies/ml & T3–4 and EBV DNA ≥ 4000 copies/ml & any T, but not for those > 70 years old and with an ACE-27 score > 1. IC + CCRT and CCRT were effective forms of chemotherapy.

中文翻译：

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在接受调强放射治疗 (IMRT) 治疗的老年鼻咽癌 (NPC) 患者中选择和验证化疗受益者：一项大型真实世界研究

本研究使用真实世界的证据，旨在确定将从化疗中受益的老年鼻咽癌 (NPC) 患者。确定了 2007 年 4 月至 2017 年 12 月期间的 1714 名老年 NPC 患者。递归分区分析 (RPA) 用于生成风险分层结果。对不同风险组的个体比较进行预后因素评估，以评估化疗的益处。中位随访时间为 59.3 (0.39–170.09) 个月。Epstein Barr 病毒 (EBV) DNA 和 T 分期包括在 RPA 生成的风险分层中，将患者分为预后良好组（EBV DNA ≤ 4000 拷贝/mL 和 T1-2）和预后不良组（EBV DNA ≤ 4000 拷贝/mL & T3–4 和 EBV DNA > 4000 拷贝/mL & 任何 T)。与训练组相比，预后良好组的总生存期 (OS) 显着高于训练组 (HR = 0.309, 95% CI 0.184–0.517; P < 0.001)，并在测试组中得到验证 (HR = 0.276, 95% CI 0.113–0.670；P = 0.002）。在预后不良组中，观察到与单纯放疗相比，放化疗 (CRT) 的 OS 显着改善 (HR = 0.70, 95% CI 0.55–0.88; P = 0.003)。接受诱导化疗 (IC) + 同步放化疗 (CCRT) 和 CCRT 的患者与单独 RT 相比 OS 显着改善（IC + CCRT 与单独 RT：P = 0.002；CCRT 与单独 RT：P = 0.008）但没有在 IC + RT 组 (P = 0.306)。ACE-27 评分分别为 0、1 和 2 分的 CRT 与单独 RT 的 5 年 OS 分别为 76.0% 对 70.0%（P = 0.014）、80.5% 对 68.2%（P = 0.150）和 58.5% 对 62.2% (P = 0.490)，分别；对于 60-64、65-70 和 ≥ 70 岁的人，他们分别为 80.9% 对 75.9%（P = 0.068）、73.3% 对 63.4%（P = 0.270）和 64.8% 对 67.1%（P = 0.820），分别。对于老年 NPC 患者，化疗受益者的简单筛查截止值可能是 EBV DNA < 4000 拷贝/ml 和 T3-4 和 EBV DNA ≥ 4000 拷贝/ml 和任何 T，但不适用于年龄 > 70 岁且具有 ACE-27 的患者评分 > 1。IC + CCRT 和 CCRT 是有效的化疗形式。