新辅助化疗免疫疗法可提高局部晚期口腔或口咽癌患者的生活质量：一项倾向评分匹配分析。

Neoadjuvant chemoimmunotherapy brings superior quality of life of patients with locally advanced oral or oropharyngeal cancer: A propensity score-matched analysis.

作者信息

Wu Wen-Jie, An Pu-Gen, Liu Qian, Zhang Zi-Qi, Hu Xiao, Yao Jie, Zhang Jie

机构信息

Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China; National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, PR China; Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, PR China.

出版信息

Oral Oncol. 2025 Mar;162:107218. doi: 10.1016/j.oraloncology.2025.107218. Epub 2025 Feb 26.

DOI:10.1016/j.oraloncology.2025.107218

PMID:40015212

Abstract

BACKGROUND

The outcomes and quality of life of patients with locally advanced oral or oropharyngeal squamous cell carcinoma (LAOOPSCC) following upfront surgery (US) are suboptimal. The optimal neoadjuvant therapy involving programmed death-1 inhibitors still remains unknown. We aimed to investigate the antitumor efficacy and quality-of-life benefits of neoadjuvant chemoimmunotherapy (NACI) and compare them with those of US for LAOOPSCC.

METHODS

A total of 570 patients with OOPSCC who underwent surgical treatment between January 2021 and January 2023 were initially reviewed and we obtained 51 unbiased patients in each of the NACI and US groups through propensity score matching based on age, sex, clinical T and N stage. The antitumor efficacy in patients in the NACI group was evaluated with the pathological response. The postoperative quality of life, as assessed with the EORTC Quality of Life Questionnaire Head and Neck 35, as well as disease-free survival and overall survival, were compared between the groups.

RESULTS

In the NACI group, the major pathological response rate was 58.8 % (30/51), and the objective response rate was 66.7 % (34/51). In NACI group, In the NACI group, patients experienced a shorter operative time (p = 0.001) and a reduced length of hospitalization post-surgery (p = 0.041), along with less intraoperative blood loss (p < 0.001) and fewer free flap reconstructions (p < 0.001). Compared with the patients in the US group, those in the NACI group had significantly better postoperative quality of life, including the sensory function (12.7 vs. 23.0, p = 0.021), speech problems (17.3 vs. 35.1, p < 0.001), social eating (20.8 vs. 31.0, p = 0.020), social contact (19.8 vs. 36.5, p < 0.001) and feeling ill (41.2 vs. 51.6, p = 0.021). There was no significant statistical difference in OS (p = 0.825) and DFS (p = 0.473) between the two groups.

CONCLUSION

The findings demonstrate the safety and feasibility of NACI and the de-escalation surgery after NACI is worth promoting to improve patient postoperative quality of life.

摘要

背景

局部晚期口腔或口咽鳞状细胞癌（LAOOPSCC）患者接受 upfront 手术（US）后的治疗效果和生活质量并不理想。涉及程序性死亡 -1 抑制剂的最佳新辅助治疗方案仍不明确。我们旨在研究新辅助化疗免疫疗法（NACI）的抗肿瘤疗效和生活质量益处，并将其与 LAOOPSCC 的 US 治疗效果进行比较。

方法

对 2021 年 1 月至 2023 年 1 月期间接受手术治疗的 570 例 OOPSCC 患者进行初步评估，通过倾向得分匹配，根据年龄、性别、临床 T 和 N 分期，在 NACI 组和 US 组中各获得 51 例无偏倚患者。通过病理反应评估 NACI 组患者的抗肿瘤疗效。比较两组患者术后的生活质量（采用欧洲癌症研究与治疗组织生活质量问卷头颈 35 项量表评估）、无病生存期和总生存期。

结果

NACI 组的主要病理反应率为 58.8%（30/51），客观反应率为 66.7%（34/51）。在 NACI 组中，患者的手术时间较短（p = 0.001），术后住院时间缩短（p = 0.041），术中失血量减少（p < 0.001），游离皮瓣重建次数减少（p < 0.001）。与 US 组患者相比，NACI 组患者术后生活质量明显更好，包括感觉功能（12.7 对 23.0，p = 0.021）、言语问题（17.3 对 35.1，p < 0.001）、社交进食（20.8 对 31.0，p = 0.02）、社交接触（19.8 对 36.5，p < 0.001）和不适感（41.2 对 51.6，p = 0.021）。两组之间的总生存期（p = 0.825）和无病生存期（p = 0.473）无显著统计学差异。