放射治疗在治疗鼻咽癌局部复发伴远处转移中的疗效：一项长期回顾性多中心研究。

Efficacy of radiotherapy in treating local recurrence concomitant with distant metastasis of nasopharyngeal carcinoma: a long-term retrospective multicenter study.

作者信息

Li Lu, Deng Mingyou, Ren Jianlan, Liao Wenjun, Zheng Liangjian, Ma Hui, Lang Jinyi, Feng Mei, Luo Yangkun

机构信息

Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.

Department of Oncology, Jiulongpo People's Hospital, Chongqing, China.

出版信息

Clin Exp Metastasis. 2025 Jan 22;42(2):11. doi: 10.1007/s10585-025-10329-2.

DOI:10.1007/s10585-025-10329-2

PMID:39843651

Abstract

PURPOSE

Patients with nasopharyngeal carcinoma (NPC) experiencing locoregional recurrence concomitant with distant metastases (rmNPC) after initial treatment represent a unique subgroup with significant management challenges. This study aimed to evaluate overall survival (OS) in rmNPC patients treated with systemic therapies with or without radiotherapy.

METHODS

This retrospective multicenter study included patients with locally recurrent and metastatic NPC from five hospitals. Kaplan-Meier analyses and log-rank tests were applied to assess survival outcomes based on recurrence and metastasis profiles, as well as treatment modalities. Independent prognostic factors affecting OS were identified using Cox regression models.

RESULTS

A total of 52 patients were analyzed, with a median follow-up duration of 68.3 months (range: 7-240 months). The median OS was 23.4 months (range: 11.1-35.6 months), and the 1-, 2-, 3-, 4-, and 5-year OS rates were 61.3%, 46.5%, 31.0%, 27.9%, and 10.5%, respectively. The treatment modality did not significantly affect OS overall (P = 0.071). Median OS was 10.8 months (95% CI, 7.7-13.9) for chemotherapy alone, 24.2 months (95% CI, 8.9-39.4) for chemotherapy combined with PD-1 inhibitors, and 47.1 months (95% CI, 10.2-84.0) for chemotherapy combined with radiotherapy. In patients with oligometastasis, radiotherapy significantly improved OS (50.1 vs. 24.1 months, P = 0.021), whereas no significant OS benefit was observed for radiotherapy in polymetastatic patients (8.6 vs. 14.8 months, P = 0.168). Similarly, radiotherapy extended OS in patients with one-organ metastases (50.1 vs. 24.1 months, P = 0.026), while no significant benefit was observed in those with multiple-organ metastases (8.6 vs. 11.0 months, P = 0.831).

CONCLUSIONS

Radiotherapy, when combined with other treatment modalities, significantly improves OS in rmNPC patients with oligometastases or one-organ metastases.

摘要

目的

接受初始治疗后出现局部区域复发并伴有远处转移的鼻咽癌（NPC）患者是一个特殊的亚组，在治疗管理上面临重大挑战。本研究旨在评估接受全身治疗联合或不联合放疗的复发转移性鼻咽癌患者的总生存期（OS）。

方法

这项回顾性多中心研究纳入了来自五家医院的局部复发和转移性鼻咽癌患者。采用Kaplan-Meier分析和对数秩检验，根据复发和转移情况以及治疗方式评估生存结果。使用Cox回归模型确定影响总生存期的独立预后因素。

结果

共分析了52例患者，中位随访时间为68.3个月（范围：7 - 240个月）。中位总生存期为23.4个月（范围：11.1 - 35.6个月），1年、2年、3年、4年和5年总生存率分别为61.3%、46.5%、31.0%、27.9%和10.5%。总体而言，治疗方式对总生存期没有显著影响（P = 0.071）。单纯化疗的中位总生存期为10.8个月（95%CI，7.7 - 13.9），化疗联合PD - 1抑制剂的中位总生存期为24.2个月（95%CI，8.9 - 39.4），化疗联合放疗的中位总生存期为47.1个月（95%CI，10.2 - 84.0）。在寡转移患者中，放疗显著改善了总生存期（50.1对24.1个月，P = 0.021），而在多转移患者中未观察到放疗对总生存期有显著益处（8.6对14.8个月，P = 0.168）。同样，放疗延长了单器官转移患者的总生存期（50.1对24.1个月，P = 0.026），而在多器官转移患者中未观察到显著益处（8.6对11.0个月，P = 0.831）。