基于递归分区分析的初治转移性鼻咽癌的预后亚组和辅助局部区域放疗的临床决策制定：一项回顾性研究。

Proposed prognostic subgroups and facilitated clinical decision-making for additional locoregional radiotherapy in de novo metastatic nasopharyngeal carcinoma: a retrospective study based on recursive partitioning analysis.

机构信息

Department of Medical Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China.

Department of Nasopharyngeal Carcinoma, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, 510060, P. R. China.

出版信息

Radiat Oncol. 2023 Jan 21;18(1):15. doi: 10.1186/s13014-022-02168-2.

BACKGROUND

The high heterogeneity of de novo metastatic nasopharyngeal carcinoma (dmNPC) makes its prognosis and treatment challenging. We aimed to accurately stage dmNPC and assess the patterns of treatment strategies for different risk groups.

METHODS

The study enrolled a total of 562 patients, 264 from 2007 to 2013 in the training cohort and 298 from 2014 to 2017 in the validation cohort. Univariate and multivariate Cox regression analyses were conducted to determine the independent variables for overall survival (OS). Recursive partitioning analysis (RPA) was applied to establish a novel risk-stratifying model based on these variables.

RESULTS

After pairwise comparisons of OS, three risk groups were generated: low-risk (involved lesions ≤ 4 without liver involvement), intermediate-risk (involved lesions ≤ 4 with liver involvement or involved lesions > 4 with Epstein-Barr virus (EBV)-DNA < 62,000 copies/ml), and high-risk (involved lesions > 4 with EBV-DNA > 62,000 copies/ml). The 3-year OS rate differed significantly between groups (80.4%, 42.0%, and 20.4%, respectively, all P < 0.05). Adding locoregional intensity-modulated radiotherapy (LRRT) followed by palliative chemotherapy (PCT) resulted in a significant OS benefit over PCT alone for the low- and intermediate-risk groups (P = 0.0032 and P = 0.0014, respectively). However, it provided no survival benefits for the high-risk group (P = 0.6). Patients did not benefit from concurrent chemotherapy during LRRT among the three subgroups (P = 0.12, P = 0.13, and P = 0.3, respectively). These results were confirmed with the validation cohort.

CONCLUSIONS

The novel RPA model revealed superior survival performance in subgroup stratification and could facilitate more effective treatment strategies for dmNPC.

背景

初发性转移性鼻咽癌（dmNPC）的高度异质性使其预后和治疗极具挑战性。我们旨在准确分期 dmNPC，并评估不同风险组的治疗策略模式。

方法

本研究共纳入 562 例患者，其中训练队列 264 例（2007 年至 2013 年），验证队列 298 例（2014 年至 2017 年）。采用单变量和多变量 Cox 回归分析确定总生存期（OS）的独立变量。应用递归分区分析（RPA）基于这些变量建立一种新的风险分层模型。

结果

在 OS 的两两比较后，生成了三个风险组：低危组（受累病灶≤4 个且无肝脏受累）、中危组（受累病灶≤4 个伴肝脏受累或受累病灶>4 个且 EBV-DNA<62,000 拷贝/ml）和高危组（受累病灶>4 个且 EBV-DNA>62,000 拷贝/ml）。三组 3 年 OS 率差异有统计学意义（分别为 80.4%、42.0%和 20.4%，均 P<0.05）。与单独进行姑息性化疗（PCT）相比，在低危和中危组中，加局部区域调强放疗（LRRT）后再进行 PCT 治疗显著提高了 OS（P=0.0032 和 P=0.0014）。然而，高危组的生存获益无统计学意义（P=0.6）。在三个亚组中，LRRT 期间进行同期化疗对患者没有生存获益（分别为 P=0.12、P=0.13 和 P=0.3）。这些结果在验证队列中得到了证实。