To evaluate the impact of three to four cycles of neoadjuvant chemotherapy (NACT) on the survival of patients with N₂-N₃ nasopharyngeal carcinoma (NPC).

The clinical data of 915 patients with T_1-4N_2-3M₀ NPC from 2007 to 2010 were retrospectively analyzed. A total of 179 patients treated with 3-4 cycles of NACT (NACT≥3 group) were matched with 358 patients treated with 2 cycles of NACT (NACT=2 group) and 179 patients treated without NACT (NACT=0 group, concurrent chemoradiotherapy group) for age, N stage, pathological subtype, and NACT regimen. The Kaplan-Meier method was used to calculate overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and distant metastasis-free survival (DMFS) rates, the log-rank test was used for survival difference analysis and univariate prognostic analysis, and the Cox proportional hazards model was used for multivariate prognostic analysis.

For the NACT≥3, NACT=2, and NACT=0 groups, the 5-year OS rates were 89.4%, 81.6%, and 73.7%, respectively (P=0.000), the 5-year DFS rates were 83.2%, 69.8%, and 64.2%, respectively (P=0.000), the 5-year RFS rates were 86.0%, 76.0%, and 69.3%, respectively (P=0.001), and the 5-year DMFS rates were 86.6%, 76.0%, and 68.3%, respectively (P=0.000). Three to four cycles of NACT was an independent protective factor for OS, DFS, RFS, and DMFS in patients with N₂-N₃ NPC.

Three to four cycles of NACT can significantly improve the survival of patients with N₂-N₃ NPC.

Nasopharyngeal neoplasms/neoadjuvent chemotherapy; Prognosis