Fang Min, Hu Yujun, Wang Tiejun, Su Yong, Lu Tianzhu, Zhang Hao, Li Jingao, Xie Chuanmiao, Gong Xiaochang
Department of Oncology, Gaoxin Branch of The First Affiliated Hospital of Nanchang University, Nanchang, 330000, People's Republic of China.
NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, 330029, People's Republic of China.
J Inflamm Res. 2025 May 26;18:6783-6794. doi: 10.2147/JIR.S512808. eCollection 2025.
This study investigates the predictive value of early C-reactive protein (CRP) kinetics in patients with de novo metastatic nasopharyngeal carcinoma (dmNPC) receiving first-line chemotherapy combined with anti-PD-1 mAbs (first-line chemoimmunotherapy).
Patients were categorized into three groups based on early CRP kinetics within one and three months after the start of immunotherapy: (1) CRP flare-responders, with CRP levels rising to more than double the baseline within one month and subsequently falling below baseline within three months; (2) CRP non-flare-responders, with CRP levels decreasing by more than 30% within three months without initial flare; (3) CRP non-responders, with no significant CRP changes. Associations with objective response rate (ORR), and progression-free survival (PFS) were evaluated.
The multicenter study included 149 patients with dmNPC (median follow-up: 22 months). The cohort comprised 39 (26.2%) CRP flare-responders, 76 (51%) CRP non-flare-responders, and 34 (22.8%) CRP non-responders. CRP flare-responders and non-flare-responders were combined into CRP responders, showing significantly improved ORR (94.8% vs 79.4%, P=0.009) and prolonged median PFS (20 vs 13 months, P=0.006) compared to CRP non-responders. Multivariable analysis identified early CRP kinetics as an independent prognostic factor for PFS (HR=2.688, 95% CI: 1.484-4.868, P<0.001). In subgroup analysis, patients with undetectable EBV DNA after three immunotherapy cycles showed higher median PFS among CRP responders compared to non-responders (28 vs 21 months, P=0.014), whereas no significant difference was observed in patients with detectable EBV DNA levels (13 vs 8 months, P=0.142).
CRP responders are associated with improved survival outcomes, particularly in patients achieving early EBV DNA clearance. Early CRP kinetics combined with early plasma EBV DNA clearance may be predictive of survival outcomes in dmNPC patients receiving first-line chemoimmunotherapy.
本研究探讨初治转移性鼻咽癌（dmNPC）患者接受一线化疗联合抗程序性死亡蛋白1（PD-1）单克隆抗体（一线化疗免疫治疗）时早期C反应蛋白（CRP）动力学的预测价值。
根据免疫治疗开始后1个月和3个月内的早期CRP动力学将患者分为三组：（1）CRP爆发反应者，CRP水平在1个月内升至基线的两倍以上，随后在3个月内降至基线以下；（2）CRP非爆发反应者，CRP水平在3个月内下降超过30%且无初始爆发；（3）CRP无反应者，CRP无显著变化。评估其与客观缓解率（ORR）和无进展生存期（PFS）的相关性。
这项多中心研究纳入了149例dmNPC患者（中位随访时间：22个月）。该队列包括39例（26.2%）CRP爆发反应者、76例（51%）CRP非爆发反应者和34例（22.8%）CRP无反应者。CRP爆发反应者和非爆发反应者合并为CRP反应者，与CRP无反应者相比，其ORR显著提高（94.8%对79.4%，P=0.009），中位PFS延长（20个月对13个月，P=0.006）。多变量分析确定早期CRP动力学是PFS的独立预后因素（风险比=2.688，95%置信区间：1.484-4.868，P<0.001）。在亚组分析中，三个免疫治疗周期后EBV DNA检测不到的患者中，CRP反应者的中位PFS高于无反应者（28个月对21个月，P=0.014），而EBV DNA水平可检测的患者中未观察到显著差异（13个月对8个月，P=0.142）。
CRP反应者与生存结局改善相关，尤其是在早期实现EBV DNA清除的患者中。早期CRP动力学与早期血浆EBV DNA清除相结合可能预测接受一线化疗免疫治疗的dmNPC患者的生存结局。
