Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Head Neck. 2023 Oct;45(10):2571-2579. doi: 10.1002/hed.27480. Epub 2023 Aug 9.
Our objective was to establish a prognostic model for patients with de novo metastatic nasopharyngeal carcinoma (NPC) who received chemotherapy followed by locoregional radiotherapy (LRRT) to identify candidates for metastasis-directed therapy (MDT).
De novo metastatic NPC patients who received chemotherapy followed by LRRT were enrolled. Propensity score matching (PSM) method was used to compare overall survival (OS) for patients receiving LRRT alone and MDT plus LRRT. We developed a predictive model to predict survival and estimate the outcome of stratified therapy and identify suitable candidates for MDT.
A total of 107 patients received MDT plus LRRT and 178 received LRRT alone were enrolled. PSM analysis identified 107 patients in each cohort and showed that MDT plus LRRT was associated with a significant survival benefit (HR: 0.640; 95% CI, 0.29-0.956; p = 0.027). Based on five independent prognostic factors, including metastases number, serum lactate dehydrogenase, liver metastasis, C-reactive protein, and tumor response, a prognostic model was established. All patients were stratified according to the prognostic score obtained by the prognostic model. In the low-risk group, MDT plus LRRT group revealed a significant improvement for OS compared with LRRT alone group (5-year OS, 69.9% vs. 57.8%, p = 0.020). However, no significant difference was observed between MDT plus LRRT group and LRRT alone in the high-risk group (p = 0.75).
MDT plus LRRT was associated with improved OS in patients with de novo metastatic NPC, especially low-risk patients identified with a newly developed prognostic model.
我们的目的是建立一个接受化疗后继以局部区域放疗（LRRT）的初诊转移性鼻咽癌（NPC）患者的预后模型，以确定转移导向治疗（MDT）的候选者。
入组接受化疗后继以 LRRT 的初诊转移性 NPC 患者。采用倾向评分匹配（PSM）方法比较仅接受 LRRT 和 MDT 加 LRRT 的患者的总生存期（OS）。我们开发了一个预测模型来预测生存并估计分层治疗的结果，并确定适合 MDT 的患者。
共有 107 例患者接受 MDT 加 LRRT，178 例患者单独接受 LRRT。PSM 分析确定了每个队列中的 107 例患者，结果显示 MDT 加 LRRT 与生存获益显著相关（HR：0.640；95%CI，0.29-0.956；p=0.027）。基于 5 个独立的预后因素，包括转移数量、血清乳酸脱氢酶、肝转移、C 反应蛋白和肿瘤反应，建立了一个预后模型。根据预后模型获得的预后评分对所有患者进行分层。在低危组中，与单独接受 LRRT 相比，MDT 加 LRRT 组的 OS 显著改善（5 年 OS，69.9%对 57.8%，p=0.020）。然而，在高危组中，MDT 加 LRRT 组与单独接受 LRRT 组之间没有观察到显著差异（p=0.75）。
MDT 加 LRRT 可改善初诊转移性 NPC 患者的 OS，特别是在使用新开发的预后模型确定的低危患者中。
