复发性或转移性鼻咽癌一线治疗的疗效与安全性：一项系统评价和网状Meta分析
Efficacy and safety of first-line treatments for recurrent or metastatic nasopharyngeal carcinoma: a systematic review and network meta-analysis.
作者信息
Cai Tongze, Lin Caiyue, Li Qiongqian, Mo Juanmei, Zheng Jinghui, Zhou Jianlong
机构信息
Guangxi International Zhuang Medicine Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China.
Graduate School, Guangxi University of Chinese Medicine, Nanning, China.
出版信息
Front Immunol. 2025 Jun 9;16:1485609. doi: 10.3389/fimmu.2025.1485609. eCollection 2025.
BACKGROUND
To compare the efficacy and safety of first-line treatments for recurrent or metastatic nasopharyngeal carcinoma (RM-NPC).
METHODS
We searched databases, including PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and major international conferences, to identify comparative randomized controlled trials (RCTs) for the first-line treatment of patients with nasopharyngeal carcinoma who have metastasis or recurrence from inception to March 1, 2024. Then, we conducted a Bayesian network meta-analysis and systematic review of RCTs that met the specified inclusion criteria. By calculating the surface under the cumulative ranking curve (SUCRA) for each treatment, we determined their relative advantage: the higher the SUCRA score, the more likely that treatment is to be the optimal choice.
RESULTS
Seven RCTs were included, which involved 1495 patients who received 8 different treatment regimens. Overall, programmed cell death protein 1 (PD-1) inhibitors combined with chemotherapy could be the optimal treatment for patients with RM-NPC. Chemotherapy combined with radiotherapy has a tendency to improve progression-free survival and overall survival. The safety assessment showed no significant difference in the incidence of grade 3 or higher adverse events between any two treatments. Tislelizumab, combined with the standard first-line chemotherapy regimen, appeared to confer the best progression-free survival (SUCRA = 83.16%), overall survival (SUCRA = 83.16%), and objective response rate (SUCRA = 89%).
CONCLUSIONS
Systematic reviews and network meta-analyses integrate evidence from multiple studies, which enables clinicians to make more informed treatment decisions based on comprehensive comparative efficacy and safety data. For patients with RM-NPC, the combination of tislelizumab and chemotherapy is the optimal first-line treatment.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023491570, identifier CRD42023491570.
背景
比较复发性或转移性鼻咽癌（RM-NPC）一线治疗的疗效和安全性。
方法
我们检索了包括PubMed、Embase、Cochrane图书馆、ClinicalTrials.gov以及主要国际会议在内的数据库，以确定从开始到2024年3月1日对发生转移或复发的鼻咽癌患者进行一线治疗的比较随机对照试验（RCT）。然后，我们对符合指定纳入标准的RCT进行了贝叶斯网络荟萃分析和系统评价。通过计算每种治疗的累积排名曲线下面积（SUCRA），我们确定了它们的相对优势：SUCRA分数越高，该治疗成为最佳选择的可能性就越大。
结果
纳入了7项RCT，涉及1495例接受8种不同治疗方案的患者。总体而言，程序性细胞死亡蛋白1（PD-1）抑制剂联合化疗可能是RM-NPC患者的最佳治疗方法。化疗联合放疗有改善无进展生存期和总生存期的趋势。安全性评估显示，任何两种治疗之间3级或更高等级不良事件的发生率无显著差异。替雷利珠单抗联合标准一线化疗方案似乎能带来最佳的无进展生存期（SUCRA = 83.16%）、总生存期（SUCRA = 83.16%）和客观缓解率（SUCRA = 89%）。
结论
系统评价和网络荟萃分析整合了多项研究的证据，使临床医生能够根据全面的比较疗效和安全性数据做出更明智的治疗决策。对于RM-NPC患者，替雷利珠单抗与化疗联合是最佳的一线治疗方法。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023491570，标识符CRD42023491570。
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