Gao Xianlu, Fu Shuwen, Yang Chulin, Jiang Wenmei, Liang Jiadong, Li Ruiyu, Yan Shida, Du Mingyuan, Yang Shiyan, Zhang Quan, Chen Shuwei
Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.
State Key Laboratory of Oncology in South China, Guangzhou, China.
Cancer Med. 2025 May;14(9):e70869. doi: 10.1002/cam4.70869.
This study aims to evaluate the antitumor activity of neoadjuvant immunochemotherapy in patients with cervical metastatic squamous cell carcinoma of unknown primary (CMSCCUP), providing a new idea for its treatment.
We retrospectively examined the medical records from Sun Yat-sen University Cancer Center to identify patients with CMSCCUP from July 2020 to November 2023. CMSCCUP's diagnoses are based on the results of biopsy and imaging examination. All patients received PD-1 inhibitors combined with chemotherapy: paclitaxel (Albumin-bound) 260 mg/m and cisplatin 60 mg/m every 3 weeks for two or more cycles as their initial treatment. Clinical response after neoadjuvant immunochemotherapy was assessed using Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1. Surgery, radiotherapy, or chemoradiotherapy was performed subsequently based on the imaging evaluation results. Outcomes included overall survival (OS) and disease-free survival (DFS).
After neoadjuvant immunochemotherapy, the objective response rate (ORR) was 84.2%; complete response (CR), partial response (PR), and stable disease (SD) were 36.8%, 47.4%, and 15.8%, respectively. Of the 9 patients (42.9%) who underwent surgery after neoadjuvant immunochemotherapy, 7 (77.8%) achieved pathological complete response (pCR). No severe treatment-related adverse events occurred. The most common treatment-related adverse events were Grade 1-2 fatigue (11/14, 78.6%), decreased appetite (11/15, 73.3%), and increased aspartate transaminase (12/20, 60.0%). One (1/20, 5.0%) patient experienced Grade 3 anemia. The 2-year overall survival (OS) and 2-year disease-free survival (DFS) rates were 94.4% and 89.4%, respectively.
Neoadjuvant immunochemotherapy showed favorable efficacies, anticipated outcomes, and tolerable toxicity for patients with CMSCCUP. More clinical practice and clinical studies are still needed to confirm further.
本研究旨在评估新辅助免疫化疗对宫颈转移性未知原发灶鳞状细胞癌（CMSCCUP）患者的抗肿瘤活性，为其治疗提供新思路。
我们回顾性查阅了中山大学肿瘤防治中心2020年7月至2023年11月期间的病历，以确定CMSCCUP患者。CMSCCUP的诊断基于活检和影像学检查结果。所有患者均接受PD-1抑制剂联合化疗：每3周使用紫杉醇（白蛋白结合型）260mg/m²和顺铂60mg/m²，共进行两个或更多周期作为初始治疗。新辅助免疫化疗后的临床反应采用实体瘤疗效评价标准（RECIST）1.1版进行评估。随后根据影像学评估结果进行手术、放疗或放化疗。观察指标包括总生存期（OS）和无病生存期（DFS）。
新辅助免疫化疗后，客观缓解率（ORR）为84.2%；完全缓解（CR）、部分缓解（PR）和疾病稳定（SD）分别为36.8%、47.4%和15.8%。在新辅助免疫化疗后接受手术的9例患者（42.9%）中，7例（77.8%）达到病理完全缓解（pCR）。未发生严重的治疗相关不良事件。最常见的治疗相关不良事件为1-2级疲劳（11/14，78.6%）、食欲下降（11/15，73.3%）和天门冬氨酸转氨酶升高（12/20，60.0%）。1例（1/20，5.0%）患者出现3级贫血。2年总生存期（OS）和2年无病生存期（DFS）率分别为94.4%和89.4%。
新辅助免疫化疗对CMSCCUP患者显示出良好的疗效、预期结果和可耐受的毒性。仍需要更多的临床实践和临床研究来进一步证实。
