Wang Lili, Zhuang Hengzhao, Xu Xiaoyan, Zhou Juying, Jiao Yang
Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.
School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China.
Front Oncol. 2023 Feb 6;13:1129649. doi: 10.3389/fonc.2023.1129649. eCollection 2023.
This study investigated the curative effect of adding nimotuzumab (NTZ) in patients with locally advanced nasopharyngeal carcinoma (NPC) who were treated with concurrent chemoradiotherapy (CCRT) and explored significant prognostic factors of NPC.
The clinical data of 307 patients with NPC treated in the First Affiliated Hospital of Soochow University from January 2013 to December 2018 were retrospectively analyzed. The patients were divided into the NTZ-CCRT group and the CCRT group according to whether they were associated with NTZ. We applied propensity score matching to reduce the interference of biases and compared the short-term efficacy and long-term survival rate of the two groups. Moreover, univariate and multivariate analyses were performed for all patients, and subgroup analysis was used to compare the efficacy of therapy combined with NTZ in different subgroups.
In primary nasopharyngeal tumors, the objective response rates in the NTZ-CCRT group and CCRT group were 95.8% and 85.7%, respectively (P =0.007). In cervical positive lymph nodes, the objective response rates in the NTZ-CCRT group and CCRT group were 98.3% and 87.4%, respectively (P =0.001). Compared with CCRT alone, the addition of NTZ significantly improved the 5-year OS (94.1% vs. 81.8%, P=0.014) and the 5-year DFS (84.2% vs. 75.5%, P=0.031) of NPC patients; however, the addition of NTZ was accompanied by more severe hematologic toxicity and acute oral mucositis. Multivariate analysis demonstrated that the addition of NTZ was an important prognostic factor for OS and DFS (HR 0.367, 95% CI 0.167-0.808, P=0.013 for OS and HR 0.536, 95% CI 0.312-0.919, P=0.023 for DFS) and the level of pretreatment LDH (HR 5.170, 95% CI 2.125-12.580, P<0.001 for OS and HR 2.421, 95% CI 1.027-5.707, P=0.043 for DFS). Moreover, patients with high levels of hsCRP before treatment (HR 0.389, 95% CI 0.177-0.853, P=0.018) may gain more benefits from combined treatment with NTZ.
For locally advanced NPC patients treated with concurrent chemoradiotherapy, the addition of NTZ can significantly improve their survival outcome. However, it is necessary to guard against the associated increase in hematological toxicity and acute oral mucositis.
本研究探讨在局部晚期鼻咽癌（NPC）患者同步放化疗（CCRT）中加用尼妥珠单抗（NTZ）的疗效，并探索NPC的重要预后因素。
回顾性分析2013年1月至2018年12月在苏州大学附属第一医院接受治疗的307例NPC患者的临床资料。根据是否联用NTZ将患者分为NTZ-CCRT组和CCRT组。我们应用倾向评分匹配以减少偏倚的干扰，并比较两组的短期疗效和长期生存率。此外，对所有患者进行单因素和多因素分析，并采用亚组分析比较不同亚组中联合NTZ治疗的疗效。
在原发性鼻咽肿瘤中，NTZ-CCRT组和CCRT组的客观缓解率分别为95.8%和85.7%（P =0.007）。在颈部阳性淋巴结中，NTZ-CCRT组和CCRT组的客观缓解率分别为98.3%和87.4%（P =0.001）。与单纯CCRT相比，加用NTZ显著提高了NPC患者的5年总生存率（94.1%对81.8%，P=0.014）和5年无病生存率（84.2%对75.5%，P=0.031）；然而，加用NTZ伴随着更严重的血液学毒性和急性口腔黏膜炎。多因素分析表明，加用NTZ是总生存率和无病生存率的重要预后因素（总生存率的HR为0.367，95%CI为0.167-0.808，P=0.013；无病生存率的HR为0.536，95%CI为0.312-0.919，P=0.023）以及治疗前乳酸脱氢酶水平（总生存率的HR为5.170，95%CI为2.125-12.580，P<0.001；无病生存率的HR为2.421，95%CI为1.027-5.707，P=0.043）。此外，治疗前高敏C反应蛋白水平高的患者（HR为0.389，95%CI为0.177-0.853，P=0.018）可能从联合NTZ治疗中获益更多。
对于接受同步放化疗的局部晚期NPC患者，加用NTZ可显著改善其生存结局。然而，有必要防范相关的血液学毒性和急性口腔黏膜炎增加。
