研究调查了诱导化疗（IC）在淋巴结阳性（LN-positive）III期鼻咽癌（NPC）接受同步化疗放疗（CCRT）中的作用。总计纳入了627例新诊断的LN-positive III期NPC接受CCRT或IC加CCRT的患者。主要终点指标为无进展生存期（PFS）。进行了倾向得分匹配（PSM）以平衡组间协变量。采用Kaplan-Meier方法和log-rank检验来比较生存曲线。根据基线特征进行了亚组分析。 1:1 PSM后，鉴定出了414例患者（每组207例患者）。与CCRT相比，IC加CCRT提供了更好的生存（5年PFS为88.4% vs. 78.6%，P = 0.01；总生存期【OS】为94.8% vs. 85.3%，P = 0.003；而远处转移无进展生存期【DMFS】为93.1% vs. 85.6%，P = 0.03）。IC对于PFS的益处主要存在于2-3级ENE、血清乳酸脱氢酶（LDH > 170U/L）升高以及N2病变的患者中。2级CNN患者与0-1级CNN患者在PFS上的益处相当。对于0-1级ENE合并LDH ≤ 170U/L的患者，两组间生存差异相似，5年PFS分别为93.6% vs. 90.4% (P = 0.50)，OS为94.2% vs. 93.0% (P = 0.72)，而DMFS为98.6% vs. 97.7% (P = 0.98)。 在CCRT之前添加IC改善了LN-positive III期NPC患者的生存。对于0-1级ENE合并LDH ≤ 170U/L的患者，额外的IC并没有提供更好的生存，可以在该人群中避免使用。CNN可能不是一个适合个体化治疗方案的好危险因素。版权所有 © 2023 Elsevier Ltd. 保留所有权利。

To investigate the role of induction chemotherapy (IC) in lymph node-positive (LN-positive) stage III nasopharyngeal carcinoma (NPC) receiving concurrent chemoradiotherapy (CCRT).In total, 627 patients with newly diagnosed LN-positive stage III NPC receiving CCRT or IC plus CCRT were included. The primary endpoint was progression-free survival (PFS). Propensity-score matching (PSM) was conducted to balance the intergroup covariates. Kaplan-Meier method with log-rank test was employed to compare survival curves. Subgroup analyses were conducted based on baseline characteristics.After 1:1 PSM, 414 patients were identified (207 patients per group). Compared with CCRT, IC plus CCRT provided better survival (5-year PFS 88.4% vs. 78.6%, P = 0.01; overall survival [OS] 94.8% vs. 85.3%, P = 0.003; and distant metastasis-free survival [DMFS] 93.1% vs. 85.6%, P = 0.03). The IC beneficial effects on PFS were mainly present in patients with grade 2-3 ENE, elevated serum lactate dehydrogenase (LDH > 170U/L), and N2 disease. Patients with grade 2 CNN had comparable PFS benefits to those with grade 0-1 CNN. For patients with grade 0-1 ENE combined with LDH ≤ 170U/L, survival between the two groups was similar with 5-year PFS 93.6% vs. 90.4% (P = 0.50), OS 94.2% vs. 93.0% (P = 0.72), and DMFS 98.6% vs. 97.7% (P = 0.98).Adding IC before CCRT improved survival in LN-positive stage III NPC patients. Additional IC did not provide better survival for patients with grade 0-1 ENE combined with LDH ≤ 170U/L and could be avoided in this population. CNN may not be a good risk factor for tailoring a personalized treatment plan.Copyright © 2023 Elsevier Ltd. All rights reserved.