Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata city, Niigata, 950-8510, Japan.
Eur Arch Otorhinolaryngol. 2020 Aug;277(8):2341-2347. doi: 10.1007/s00405-020-05945-5. Epub 2020 Apr 1.
The importance of nivolumab for recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) is rapidly increasing. However, prognostic factors have not been determined for predicting treatment outcome. We aimed to investigate the prognostic factors in R/M HNSCC patients treated with nivolumab.
This retrospective study included 42 patients with R/M HNSCC who received nivolumab therapy. Correlations of overall survival (OS) with various patient characteristics including age, recurrent/metastatic site, performance status (PS), programmed death-ligand 1 positivity, body mass index, neutrophil-to-lymphocyte ratio, modified Glasgow prognostic score (mGPS), previous cetuximab administration, and immune-related adverse events were investigated.
The overall response rate and disease control rate were 16.7% and 45.2%, respectively. Estimated 1-year OS and progression-free survival (PFS) were 56.4% and 24.5%, respectively. Multivariate analysis revealed that PS = 2 (hazard ratio 0.147; 95% CI 0.041-0.527; p = 0.003) and mGPS = 2 (hazard ratio 0.188; 95% CI, 0.057-0.620; p = 0.006) were independent predictors of poor OS. Given that the PS and mGPS were independent prognostic factors, we classified patients into three groups according to PS and mGPS: Group 1, both PS and mGPS were 0 or 1 (n = 30); Group 2, either PS or mGPS was 2 (n = 9); Group 3, both PS and mGPS were 2 (n = 3). The OS curves were significantly stratified among the three groups.
The combination of PS and mGPS accurately predicted OS after nivolumab therapy. Preventive intervention to maintain general condition without simultaneously exceeding level 2 of PS and mGPS might be important for improving treatment outcomes of nivolumab.
纳武利尤单抗在复发性或转移性（R/M）头颈部鳞状细胞癌（HNSCC）中的重要性正在迅速增加。然而，尚未确定预测治疗结果的预后因素。本研究旨在探讨接受纳武利尤单抗治疗的 R/M HNSCC 患者的预后因素。
本回顾性研究纳入了 42 例接受纳武利尤单抗治疗的 R/M HNSCC 患者。分析了总生存期（OS）与患者年龄、复发/转移部位、体能状态（PS）、程序性死亡配体 1 阳性、体质量指数、中性粒细胞与淋巴细胞比值、改良格拉斯哥预后评分（mGPS）、之前西妥昔单抗治疗和免疫相关不良事件等各项特征的相关性。
总缓解率和疾病控制率分别为 16.7%和 45.2%。估计的 1 年 OS 和无进展生存期（PFS）分别为 56.4%和 24.5%。多因素分析显示 PS=2（风险比 0.147；95%CI 0.041-0.527；p=0.003）和 mGPS=2（风险比 0.188；95%CI，0.057-0.620；p=0.006）是 OS 不良的独立预测因素。鉴于 PS 和 mGPS 是独立的预后因素，我们根据 PS 和 mGPS 将患者分为三组：PS 和 mGPS 均为 0 或 1（n=30）；PS 或 mGPS 为 2（n=9）；PS 和 mGPS 均为 2（n=3）。三组之间 OS 曲线明显分层。
PS 和 mGPS 的联合能够准确预测纳武利尤单抗治疗后的 OS。维持一般状况而不使 PS 和 mGPS 同时超过 2 级可能对改善纳武利尤单抗治疗结果至关重要。
