Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.
Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.
Front Immunol. 2022 May 24;13:899932. doi: 10.3389/fimmu.2022.899932. eCollection 2022.
Advanced recurrent nasopharyngeal carcinoma (NPC) is a relatively common nasopharyngeal skull base disease for which there is no uniform treatment modality. Not all patients are satisfied with the efficacy of immunotherapy with or without chemotherapy.
This study included patients who underwent salvage endoscopic skull base nasopharyngectomy after immunotherapy between February 2017 and June 2021. Patient survival information was analyzed. Relevant publications were retrieved from five databases from December 1, 2011 to December 1, 2021. The outcomes of patients with advanced recurrent NPC who received programmed death 1 (PD-1) immunotherapy were collected and analyzed.
Nine patients who underwent skull base surgery, all of whom had previously undergone PD-1 immunotherapy, were included in this study. The 2-year overall survival (OS) and progression-free survival (PFS) rates of these patients were 25% and 29.2%, respectively. Eight publications involving 688 patients with advanced recurrent NPC were also included in this study. The combined complete response (CR), partial response (PR), and stable disease (SD) values were 2%, 23%, and 29%, respectively. The combined DCR included the three disease conditions, CR, PR, and SD, with a value of 53%. PD-1 monotherapy was more effective than PD-1 combination chemotherapy.
PD-1 immunotherapy may improve the remission rate in patients with recurrent NPC. Salvage endoscopic skull base nasopharyngectomy may be another option for patients with poor immunotherapeutic outcomes. For patients with advanced recurrent NPC, better evidence-based medical data are needed to determine whether they should receive immunotherapy before or after surgery.
晚期复发鼻咽癌（NPC）是一种较为常见的鼻咽颅底疾病，目前尚无统一的治疗方式。并非所有患者对免疫治疗联合或不联合化疗的疗效均满意。
本研究纳入了 2017 年 2 月至 2021 年 6 月期间接受免疫治疗后行挽救性内镜颅底鼻咽切除术的患者。分析患者的生存信息。从 2011 年 12 月 1 日至 2021 年 12 月 1 日，从 5 个数据库中检索相关文献，收集并分析接受程序性死亡 1（PD-1）免疫治疗的晚期复发 NPC 患者的结局。
本研究纳入了 9 例行颅底手术的患者，所有患者均接受过 PD-1 免疫治疗。这些患者的 2 年总生存率（OS）和无进展生存率（PFS）分别为 25%和 29.2%。本研究还纳入了 8 项涉及 688 例晚期复发 NPC 患者的研究。联合完全缓解（CR）、部分缓解（PR）和稳定疾病（SD）的比例分别为 2%、23%和 29%。联合疾病控制率（DCR）包括 CR、PR 和 SD 三种疾病状态，为 53%。PD-1 单药治疗比 PD-1 联合化疗更有效。
PD-1 免疫治疗可能提高复发 NPC 患者的缓解率。挽救性内镜颅底鼻咽切除术可能是免疫治疗效果不佳患者的另一种选择。对于晚期复发 NPC 患者，需要更好的基于证据的医学数据来确定他们是否应在手术前或手术后接受免疫治疗。
