初诊转移性鼻咽癌化疗免疫治疗有效患者中立即放疗与挽救性放疗的疗效比较
Efficacy of immediate radiotherapy versus salvage radiotherapy in patients with de novo metastatic nasopharyngeal carcinoma responsive to chemoimmunotherapy.
文献信息
| PMID | 42962562 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Q-T Zhang |
| 作者单位 | State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China. |
| 期刊 | ESMO open |
| SCI 分区 | Q1 |
| IF | 8.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 化疗免疫治疗已成为初诊转移性鼻咽癌（dmNPC）的标准一线治疗。然而，在化疗免疫治疗时代，局部区域放疗在dmNPC中的作用及最佳时机仍不明确。本研究旨在评估，对于一线化疗免疫治疗有效的患者，在远处转移控制良好的情况下，延迟至局部区域进展时才进行的挽救性局部区域放疗（SLRRT）与立即局部区域放疗（ILRRT）相比，是否会影响生存。
患者与方法： 本回顾性队列研究连续纳入一线铂类化疗联合抗程序性细胞死亡蛋白1治疗达到完全缓解或部分缓解的dmNPC患者。主要终点为总生存期（OS）。采用逆概率治疗加权（IPTW）校正基线特征。采用Kaplan-Meier分析和多因素Cox回归模型评估生存结局。
结果： 共纳入439例患者，中位随访时间为35.0个月（四分位距24.0-45.2）。其中，331例患者被分配至ILRRT队列，108例分配至SLRRT队列。经IPTW校正后，与ILRRT相比，SLRRT与OS不劣相关[2年OS，97.4%对90.1%；风险比（HR）0.93，95%置信区间（CI）0.54-1.59，P=0.78]。SLRRT与较差的局部区域控制相关（HR 4.78，95% CI 2.98-7.66，P<0.001），但与较好的远处控制相关（HR 0.62，95% CI 0.41-0.95，P=0.03）。ILRRT队列中放疗相关不良事件明显更为频繁。
结论： 在一线化疗免疫治疗有效的患者中，将SLRRT延迟至局部区域进展并未影响生存。这些发现支持一种基于疗效反应、降阶梯的治疗策略，该策略可能减少治疗相关毒性并改善生活质量，而不对生存产生不利影响。
英文摘要
BACKGROUND: Chemoimmunotherapy has become the standard first-line treatment for de novo metastatic nasopharyngeal carcinoma (dmNPC). However, the role and optimal timing of locoregional radiotherapy in dmNPC in the chemoimmunotherapy era remain unclear. This study aims to evaluate whether salvage locoregional radiotherapy (SLRRT), deferred until locoregional progression in patients with well-controlled distant metastases, compromises survival compared with immediate locoregional radiotherapy (ILRRT) in responders to first-line chemoimmunotherapy.
PATIENTS AND METHODS: This retrospective cohort study included consecutive patients with dmNPC who achieved a complete or partial response after first-line platinum-based chemotherapy combined with anti-programmed cell death protein 1 therapy. The primary endpoint was overall survival (OS). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline characteristics. Survival outcomes were assessed using Kaplan-Meier analyses and a multivariate Cox regression model.
RESULTS: A total of 439 patients were included, with a median follow-up of 35.0 months (interquartile range, 24.0-45.2). Of these, 331 patients were assigned to the ILRRT cohort and 108 to the SLRRT cohort. After IPTW adjustment, SLRRT was not associated with inferior OS compared with ILRRT [2-year OS, 97.4% versus 90.1%; hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.54-1.59, P = 0.78]. SLRRT was associated with worse locoregional control (HR 4.78, 95% CI 2.98-7.66, P < 0.001) but better distant control (HR 0.62, 95% CI 0.41-0.95, P = 0.03). Radiotherapy-related adverse effects were substantially more frequent in the ILRRT cohort.
CONCLUSIONS: Deferring SLRRT until locoregional progression did not compromise survival among responders to first-line chemoimmunotherapy. These findings support a response-adapted, de-escalated treatment strategy that may reduce treatment-related toxicities and improve quality of life without adversely affecting survival.