Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, People's Republic of China.
Department of Radiology, Xiangtan Central Hospital, Xiangtan, People's Republic of China.
Oral Oncol. 2024 Jun;153:106834. doi: 10.1016/j.oraloncology.2024.106834. Epub 2024 May 7.
To meet the demand for personalized treatment, effective stratification of patients with metastatic nasopharyngeal carcinoma (mNPC) is essential. Hence, our study aimed to establish an M1 subdivision for prognostic prediction and treatment planning in patients with mNPC.
This study included 1239 patients with mNPC from three medical centers divided into the synchronous mNPC cohort (smNPC, n = 556) to establish an M1 stage subdivision and the metachronous mNPC cohort (mmNPC, n = 683) to validate this subdivision. The primary endpoint was overall survival. Univariate and multivariate Cox analyses identified covariates for the decision-tree model, proposing an M1 subdivision. Model performance was evaluated using time-dependent receiver operating characteristic curves, Harrell's concordance index, calibration plots, and decision curve analyses.
The proposed M1 subdivisions were M1a (≤5 metastatic lesions), M1b (>5 metastatic lesions + absent liver metastases), and M1c (>5 metastatic lesions + existing liver metastases) with median OS of 34, 22, and 13 months, respectively (p < 0.001). This M1 subdivision demonstrated superior discrimination (C-index = 0.698; 3-year AUC = 0.707) and clinical utility over those of existing staging systems. Calibration curves exhibited satisfactory agreement between predictions and actual observations. Internal and mmNPC cohort validation confirmed the robustness. Survival benefits from local metastatic treatment were observed in M1a, while immunotherapy improved survival in patients with M1b and M1c disease.
This novel M1 staging strategy provides a refined approach for prognostic prediction and treatment planning in patients with mNPC, emphasizing the potential benefits of local and immunotherapeutic interventions based on individualized risk stratification.
为了满足个性化治疗的需求，对转移性鼻咽癌（mNPC）患者进行有效分层至关重要。因此，我们旨在建立 mNPC 患者的 M1 亚分期，以进行预后预测和治疗规划。
本研究纳入了来自三个医学中心的 1239 例 mNPC 患者，分为同步性 mNPC 队列（smNPC，n=556）以建立 M1 亚分期，以及异时性 mNPC 队列（mmNPC，n=683）以验证该亚分期。主要终点为总生存期。单变量和多变量 Cox 分析确定了决策树模型的协变量，提出了 M1 亚分期。使用时间依赖性接收者操作特征曲线、Harrell 一致性指数、校准图和决策曲线分析来评估模型性能。
提出的 M1 亚分期为 M1a（≤5 个转移病灶）、M1b（>5 个转移病灶+无肝转移）和 M1c（>5 个转移病灶+存在肝转移），中位总生存期分别为 34、22 和 13 个月（p<0.001）。与现有分期系统相比，该 M1 亚分期具有更好的区分度（C 指数=0.698；3 年 AUC=0.707）和临床实用性。校准曲线显示预测与实际观察之间具有良好的一致性。内部和 mmNPC 队列验证证实了该模型的稳健性。在 M1a 中观察到局部转移性治疗的生存获益，而免疫治疗改善了 M1b 和 M1c 疾病患者的生存。
这种新的 M1 分期策略为 mNPC 患者的预后预测和治疗规划提供了一种精细化方法，强调了基于个体化风险分层的局部和免疫治疗干预的潜在获益。
