He Shui-Qing, Liu Guo-Ying, Yu Ya-Hui, Wang Lin, Zhang Guo-Yi, Peng Ding-Sheng, Bei Wei-Xin, Chen Chun-Lan, Lv Shu-Hui, Zhao Ze-Yu, Huang Ying, Xiang Yan-Qun
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 510060, Guangzhou, China.
Department of Oncology, 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.
Radiother Oncol. 2025 Feb;203:110687. doi: 10.1016/j.radonc.2024.110687. Epub 2024 Dec 19.
To evaluate the efficacy of local-regional radiotherapy (LRRT) in de novo metastatic nasopharyngeal carcinoma (dm NPC) patients receiving chemo-immunotherapy as first-line treatment and select the beneficiaries from LRRT.
M1-NPC patients receiving platinum-based chemo-immunotherapy with or without LRRT from four centers were included in this study. The propensity score matching (PSM) analysis was employed to balance the baseline characteristics between the LRRT and non-LRRT groups.
546 dm NPC patients (140 patients in the non-LRRT group and 406 patients in the LRRT group) were incorporated. Patients receiving LRRT demonstrated significantly improved progression-free survival (3-year PFS rate, 53.2 % vs 31.2 %, p < 0.001). After PSM analysis, there were 244 patients in the LRRT group and 122 patients in the non-LRRT group. Multivariable analysis indicated that LRRT was not an independent prognostic factor in the matched cohort (HR, 1.25, 95 % CI, 0.92-1.69, p = 0.156). Subgroup analysis among the matched cohort showed a significant increase in PFS for patients with oligo metastatic disease (OMD) who received LRRT (3-year PFS rate, 70.6 % vs 49.3 %, p = 0.043). In contrast, no such benefit was observed in patients with poly metastatic disease (PMD, 3-year PFS rate, 35.8 % vs 27.8 %, p = 0.17). Furthermore, LRRT significantly enhanced survival in patients with undetectable EBV DNA (3-year PFS rate, 57.9 % vs. 43.4 %, p = 0.043), whereas no survival improvement was noted in patients with detectable EBV DNA (16.2 % vs. 20.3 %, p = 0.21).
LRRT could prolong PFS in M1-NPC patients. OMD and undetectable EBV DNA are potential indicators for selecting beneficiaries from LRRT.
评估局部区域放疗（LRRT）在一线接受化疗免疫治疗的初发性转移性鼻咽癌（dm NPC）患者中的疗效，并从LRRT中筛选出受益患者。
本研究纳入了来自四个中心的接受含铂化疗免疫治疗且接受或未接受LRRT的M1期鼻咽癌患者。采用倾向评分匹配（PSM）分析来平衡LRRT组和非LRRT组之间的基线特征。
共纳入546例dm NPC患者（非LRRT组140例，LRRT组406例）。接受LRRT的患者无进展生存期显著改善（3年无进展生存率，53.2%对31.2%，p<0.001）。PSM分析后，LRRT组有244例患者，非LRRT组有122例患者。多变量分析表明，LRRT在匹配队列中不是独立的预后因素（HR，1.25，95%CI，0.92 - 1.69，p = 0.156）。匹配队列中的亚组分析显示，接受LRRT的寡转移疾病（OMD）患者的无进展生存期显著增加（3年无进展生存率，70.6%对49.3%，p = 0.043）。相比之下，多转移疾病（PMD）患者未观察到此类益处（3年无进展生存率，35.8%对27.8%，p = 0.17）。此外，LRRT显著提高了EBV DNA检测不到的患者的生存率（3年无进展生存率，57.9%对43.4%，p = 0.043），而EBV DNA可检测到的患者未观察到生存率提高（16.2%对20.3%，p = 0.21）。
LRRT可延长M1期鼻咽癌患者的无进展生存期。OMD和EBV DNA检测不到是从LRRT中筛选受益患者的潜在指标。
