Shang Kai, He Qianyong, Xu Xinyu, Luo Xunyan, Zhao Chaofen, Liu Lina, Li Zhuoling, Li Yuanyuan, Jin Feng
Department of Oncology, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
Ther Clin Risk Manag. 2025 Jan 6;21:15-25. doi: 10.2147/TCRM.S489899. eCollection 2025.
Analyze the incidence and risk factors of thyroid dysfunction in patients with advanced nasopharyngeal carcinoma (LA-NPC) after intensity-modulated radiotherapy (IMRT) and PD⁃1 inhibitor treatment and their relationship with treatment efficacy and prognosis.
Eighty-five LA-NPC patients treated with IMRT and PD-1 inhibitors were retrospectively collected from March 1, 2019, to May 30, 2022. The incidence of thyroid dysfunction after combination therapy was analyzed. The Kaplan-Meier method was used to analyze the relationship between thyroid dysfunction and patient prognosis. Logistic regression analysis was used to screen independent risk factors for thyroid dysfunction.
As of data cutoff (May 31, 2024), the median follow-up time was 27.8 months (range: 25.6 to 32.0 months). The median time of onset of thyroid dysfunction was 8.26 months. The incidence of thyroid dysfunction is 47.06% (40/85), with clinical hypothyroidism being the main cause at an incidence rate of 28.24% (24/85) and clinical hyperthyroidism at an incidence rate of 3.53% (3/85). The incidence of grade 1 thyroid immune-related adverse events (irAEs) was 29.41% (25/85), and the incidence of grade 2 thyroid irAEs was 17.65% (15/85). Patients with thyroid dysfunction had longer overall survival, progression-free survival, and distant metastasis-free survival at both one and two years compared to patients with normal thyroid function, but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis showed that pretreatment lactate dehydrogenase (LDH) (p = 0.079) is an independent predictor of thyroid dysfunction after radiotherapy in combination with immunotherapy for LA-NPC.
The study found that the addition of immunotherapy increases the risk and shortens the onset time of thyroid dysfunction in LA-NPC patients treated with chemoradiotherapy. Pretreatment LDH may serve as an independent risk factor for thyroid dysfunction for LA-NPC patients.
分析局部晚期鼻咽癌（LA-NPC）患者在调强放射治疗（IMRT）及PD⁃1抑制剂治疗后甲状腺功能障碍的发生率、危险因素及其与治疗疗效和预后的关系。
回顾性收集2019年3月1日至2022年5月30日期间接受IMRT和PD-1抑制剂治疗的85例LA-NPC患者。分析联合治疗后甲状腺功能障碍的发生率。采用Kaplan-Meier法分析甲状腺功能障碍与患者预后的关系。采用Logistic回归分析筛选甲状腺功能障碍的独立危险因素。
截至数据截止（2024年5月31日），中位随访时间为27.8个月（范围：25.6至32.0个月）。甲状腺功能障碍的中位发病时间为8.26个月。甲状腺功能障碍的发生率为47.06%（40/85），其中临床甲状腺功能减退为主要原因，发生率为28.24%（24/85），临床甲状腺功能亢进发生率为3.53%（3/85）。1级甲状腺免疫相关不良事件（irAEs）的发生率为29.41%（25/85），2级甲状腺irAEs的发生率为17.65%（15/85）。与甲状腺功能正常的患者相比，甲状腺功能障碍患者在1年和2年时的总生存期、无进展生存期和无远处转移生存期更长，但差异无统计学意义（p>0.05）。多因素Logistic回归分析显示，治疗前乳酸脱氢酶（LDH）（p = 0.079）是LA-NPC放疗联合免疫治疗后甲状腺功能障碍的独立预测因素。
研究发现，免疫治疗的加入增加了LA-NPC放化疗患者甲状腺功能障碍的风险并缩短了其发病时间。治疗前LDH可能是LA-NPC患者甲状腺功能障碍的独立危险因素。
