部分缓解型下咽鳞状细胞癌患者诱导后治疗策略的生存结局：一项倾向评分加权分析

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中文摘要

背景： 大多数下咽鳞状细胞癌（HPSCC）患者在诱导化疗后达到部分缓解（PR）。然而，诱导后的最佳管理仍存在争议。我们比较了PR-HPSCC诱导后策略的生存结局，重点关注诱导后晚期肿瘤分期（ycT），并使用逆概率治疗加权（IPTW-ATO）以减轻适应证混杂。
方法： 这项回顾性研究纳入149例诱导化疗后达到PR的HPSCC患者，这些患者随后接受以手术为基础的治疗（SBT；n=71）或根治性放化疗（CRT；n=78）。使用IPTW-ATO处理组间协变量不平衡。采用加权Kaplan-Meier分析和IPTW-ATO校正的Cox比例风险模型评估总生存期（OS）和无进展生存期（PFS）。敏感性分析在未校正、多变量和倾向评分加权模型之间比较结果。
结果： 在未校正分析中，两组间OS和PFS无显著差异。经IPTW-ATO校正后，与CRT相比，SBT与OS和PFS改善相关。探索性亚组分析提示ycT分层间可能存在差异性治疗效应；然而，交互检验无统计学显著性，并且在早期ycT疾病患者中未观察到显著生存差异。在多变量分析中，甲状腺侵犯与较差的OS独立相关，而抗PD-1治疗与OS改善相关。
结论： PR-HPSCC患者的结局具有异质性。在校正协变量不平衡后，SBT与有利的生存相关。这些发现提示PR不应被视为均一实体，诱导后ycT分类可能有助于对患者进行分层，以供未来前瞻性评估。

英文摘要

BACKGROUND: Most patients with hypopharyngeal squamous cell carcinoma (HPSCC) achieve partial response (PR) after induction chemotherapy. However, optimal post-induction management remains controversial. We compared survival outcomes of post-induction strategies for PR-HPSCC, with emphasis on advanced post-induction tumor stage (ycT) using inverse probability of treatment weighting (IPTW-ATO) to mitigate confounding by indication.
METHODS: This retrospective study included 149 patients with PR-HPSCC after induction chemotherapy who subsequently received surgery-based therapy (SBT; n = 71) or definitive chemoradiotherapy (CRT; n = 78). IPTW-ATO was used to address covariate imbalances between groups. Overall survival (OS) and progression-free survival (PFS) were evaluated using weighted Kaplan-Meier analyses and IPTW-ATO-adjusted Cox proportional hazards models. Sensitivity analyses compared findings across unadjusted, multivariable, and propensity score-weighted models.
RESULTS: In unadjusted analyses, OS and PFS did not differ significantly between groups. After IPTW-ATO adjustment, SBT was associated with improved OS and PFS versus CRT. Exploratory subgroup analyses suggested a potential differential treatment effect across ycT strata; however, interaction tests were not statistically significant, and no significant survival difference was observed in patients with early ycT disease. In multivariable analyses, thyroid invasion was independently associated with worse OS, whereas anti-PD-1 therapy was associated with improved OS.
CONCLUSIONS: Outcomes among patients with PR-HPSCC are heterogeneous. After adjustment for covariate imbalances, SBT was associated with favorable survival. These findings suggest that PR should not be treated as a uniform entity and that post-induction ycT classification may help stratify patients for future prospective evaluation.