针对复发/转移灶的局部治疗增强了鼻咽癌免疫检查点抑制剂的获益。
Local therapy to recurrent/metastatic foci augments the benefit of immune checkpoint inhibitors in nasopharyngeal carcinoma.
文献信息
| PMID | 42721861 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Xueqin Chen |
| 作者单位 | Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Shanghai Clinical Research Center for Radiation Oncology, China; Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China. |
| 期刊 | European journal of cancer (Oxford, England : 1990) |
| SCI 分区 | Q1 |
| IF | 7.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 免疫治疗在复发或转移性鼻咽癌（RM-NPC）中的成功，使得有必要重新评估局部治疗作为巩固或挽救治疗的作用。本研究旨在探讨在免疫治疗基础上加用局部治疗能否为RM-NPC患者带来有意义的生存获益。
患者与方法： 本研究回顾性纳入223例诊断为RM-NPC的患者。106例仅接受免疫检查点抑制剂治疗（ICI），117例接受局部治疗联合ICI（LOCI）。进一步采用逆概率治疗加权（IPTW）和倾向性评分匹配（PSM）以减轻主要临床相关混杂因素。采用Kaplan-Meier法和Cox比例风险模型进行生存分析并评估预后因素。
结果： 中位随访时间为32.93个月（22.23-46.37个月）。与ICI组相比，接受LOCI的患者获得了显著改善的PFS（中位PFS，30.53个月 vs 16.77个月，HR，0.524；95%CI，0.339-0.785；log-rank p = 0.0014）。在PSM和IPTW调整后，PFS获益仍然存在。在亚组分析中，对于鼻咽/颈部淋巴结复发（LRR-NPC）患者，相对于ICI组，LOCI组获得了改善的PFS，其主要获益在于改善DMFS（HR，0.437；95%CI，0.193-0.987；log-rank p = 0.0465）；对于远处转移（DM-NPC）患者，LOCI组也比ICI组产生了更优的PFS（HR，0.491；95%CI，0.289-0.834；log-rank p = 0.0072）。此外，在寡转移性NPC（≤3个病灶）患者中，LOCI组观察到PFS增强（HR，0.458；95%CI，0.212-0.989；log-rank p = 0.0416）。
结论： LOCI与复发性和异时性转移性NPC患者的PFS改善相关。选择LOCI候选者的策略值得进一步研究。
英文摘要
BACKGROUND: The success of immunotherapy in recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) necessitates a reassessment of local therapy as consolidation or salvage. This study aims to explore whether adding local therapy to immunotherapy can yield meaningful survival benefits for RM-NPC patients.
PATIENTS AND METHODS: 223 patients diagnosed with RM-NPC were retrospectively included in the study. 106 received immune checkpoint inhibitor therapy (ICI) alone, and 117 received local therapy combined with ICI (LOCI). Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were further conducted to mitigate major clinically-relevant confounders. Kaplan-Meier method and Cox proportional hazards model were used to perform survival analyses and evaluate the prognostic factors.
RESULTS: The median follow-up was 32.93 m (22.23-46.37 m). Patients receiving LOCI derived a significantly improved PFS when compared to the ICI group (median PFS, 30.53 m vs 16.77 m, HR, 0.524; 95%CI, 0.339-0.785; log-rank p = 0.0014). The PFS benefit remained after PSM and IPTW adjustment. In subgroup analysis, for patients with nasopharyngeal/nodal relapse (LRR-NPC), LOCI group achieved an improved PFS with a primary benefit in improving DMFS (HR, 0.437; 95%CI, 0.193-0.987; log-rank p = 0.0465) relative to the ICI group; and for patients with distant metastasis (DM-NPC), LOCI group also yielded a superior PFS (HR, 0.491; 95%CI, 0.289-0.834; log-rank p = 0.0072) than ICI group. Moreover, enhanced PFS was observed in LOCI group among patients with oligometastatic NPC (≤3 lesions) (HR, 0.458; 95%CI, 0.212-0.989; log-rank p = 0.0416).
CONCLUSION: LOCI was associated with improved PFS in both recurrent and metachronous metastatic NPC patients. Strategies to select candidates for LOCI warrants further investigation.