估算化疗免疫治疗后巩固性转移灶定向放疗在仅远处转移鼻咽癌中的个体化生存获益
Estimating Individualized Survival Benefit of Consolidative Metastasis-Directed Radiotherapy Following Chemoimmunotherapy in Nasopharyngeal Carcinoma With Exclusive Distant Metastasis.
文献信息
| PMID | 42921250 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Xuguang Wang |
| 作者单位 | Department of Head and Neck Surgery Sun Yat-sen University Cancer Center Guangzhou China. |
| 期刊 | MedComm |
| SCI 分区 | Q1 |
| IF | 14.1 |
| 研究类型 | AI/ML · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 在仅远处转移（定义为远处转移且无同步局部区域复发）的鼻咽癌（NPC）中，化疗免疫治疗（CIT）后巩固性转移灶定向放疗（MDRT）的最佳患者选择仍不确定。本研究旨在估算MDRT的生存获益并识别最可能获益的患者。方法：采用目标试验模拟方法，对来自两个独立中心的1083例患者进行分析，该方法包括克隆、人工删失和逆删失概率加权。结果：模拟估计MDRT策略可使3年无进展生存（PFS）限制平均生存时间延长4.2个月（95% CI：2.4-5.9；bootstrap p < 0.001）。开发并比较了八种生存机器学习算法，其中梯度提升机在内部验证中的3年PFS AUROC为0.875，在地理外部验证中为0.877。进一步使用T-learner框架在由递归分割分析定义的风险组中估计异质性治疗效应。在外部队列中，模型估计的MDRT 3年绝对风险降低在中危、低危和高危组分别为21.6%、14.7%和5.7%。结论：该框架随后被实施为基于网络的临床决策支持系统。这些发现支持CIT后巩固性MDRT的个体化选择，并为多学科决策提供了实用框架。
英文摘要
Optimal patient selection for consolidative metastasis-directed radiotherapy (MDRT) after chemoimmunotherapy (CIT) remains uncertain in nasopharyngeal carcinoma (NPC) with exclusive distant metastasis, defined as distant metastasis without synchronous locoregional recurrence. This study was aimed at estimating the survival benefit of MDRT and identifying patients most likely to benefit. A total of 1083 patients from two independent centers were analyzed using a target trial emulation with cloning, artificial censoring, and inverse probability of censoring weighting. The emulation estimated a 4.2-month gain in 3-year progression-free survival (PFS) restricted mean survival time with the MDRT strategy (95% CI: 2.4-5.9; bootstrap p < 0.001). Eight survival machine-learning algorithms were developed and compared, among which the gradient boosting machine achieved 3-year PFS AUROCs of 0.875 in internal validation and 0.877 in geographical external validation. Heterogeneous treatment effects were further estimated using a T-learner framework across risk groups defined by recursive partitioning analysis. In the external cohort, model-estimated 3-year absolute risk reductions with MDRT were 21.6%, 14.7%, and 5.7% in intermediate-, low-, and high-risk groups, respectively. The framework was subsequently implemented as a web-based clinical decision-support system. These findings support individualized selection of consolidative MDRT after CIT and provide a practical framework for multidisciplinary decision-making.