Optimal combination treatment for Locally Advanced Nasopharyngeal Carcinoma: A systematic review and Bayesian Network Meta-Analysis

IF 1.8 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology Pub Date : 2025-06-22 DOI:10.1016/j.amjoto.2025.104692

Zexin Song , Likai Chen , Qi Zhang , Yueyue Huang , Hao Pan

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引用次数: 0

Abstract

Purpose

To identify the optimal therapeutic strategy for Locally Advanced Nasopharyngeal Carcinoma (LA-NPC).

Methods

Herein, four databases (PubMed, Web of Science, Embase, and Cochrane Library) were systematically searched for pertinent articles from inception to May 24, 2024. Risk of Bias (ROB) was assessed using Cochrane's risk of bias tool 2.0. Statistical analyses were performed using Stata 16.0 and R 4.4.0.

Results

The final analysis included 46 studies involving 15,667 patients. Compared to the Concurrent Chemoradiotherapy (CCRT) + Adjuvant Chemotherapy (AC) combination therapy, the Induction Chemotherapy (IC) + CCRT + Epidermal Growth Factor Receptor Antibody (anti-EGFR) combination treatment demonstrated better efficacy in improving Overall Survival (OS) (Hazard Ratio [HR]: 0.52; 95 % Confidence Interval [CI]: 0.33–0.83). The Surface Under the Cumulative Ranking (SUCRA) analysis revealed that the IC + CCRT + AC + anti-EGFR combination ranked the highest in terms of OS, with a SUCRA score of 87.49 %. It also ranked the highest in terms of Distant Metastasis-Free Survival (DMFS), with a SUCRA score of 85.90 %. Additionally, the CCRT + anti-EGFR combination therapy ranked the highest in terms of PFS, with a SUCRA score of 77.21 %, while the IC + RT combination had the fewest Adverse Effects (AEs) (3–4 grade), with a SUCRA score of 86.20 %.

Conclusion

The IC + CCRT + AC + anti-EGFR combination therapy significantly improved OS, DMFS, and LRFS, highlighting its great promise in LA-NPC treatment. However, owing to the relatively few studies on immunotherapy and targeted therapy, more well-designed studies will be required to validate this deduction.

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局部晚期鼻咽癌的最佳联合治疗：系统回顾和贝叶斯网络荟萃分析

目的探讨局部晚期鼻咽癌（LA-NPC）的最佳治疗策略。方法系统检索PubMed、Web of Science、Embase、Cochrane Library 4个数据库，检索自建校至2024年5月24日的相关文章。偏倚风险（ROB）采用Cochrane's风险偏倚工具2.0进行评估。采用Stata 16.0和r4.4.0进行统计学分析。结果最终分析纳入46项研究，涉及15667例患者。与同步放化疗(CCRT) +辅助化疗（AC）联合治疗相比，诱导化疗(IC) + CCRT +表皮生长因子受体抗体（anti-EGFR）联合治疗在改善总生存期（OS）方面表现出更好的疗效(风险比[HR]: 0.52；95%置信区间[CI]: 0.33-0.83)。表面下累积排名（SUCRA）分析显示，IC + CCRT + AC +抗egfr组合在OS方面排名最高，SUCRA评分为87.49%。它在无远处转移生存（DMFS）方面也排名最高，SUCRA评分为85.90%。此外，CCRT +抗egfr联合治疗在PFS方面排名最高，SUCRA评分为77.21%，而IC + RT联合治疗的不良反应（ae）最少（3-4级），SUCRA评分为86.20%。结论IC + CCRT + AC +抗egfr联合治疗可显著改善OS、DMFS和LRFS，在LA-NPC治疗中具有广阔的应用前景。然而，由于免疫治疗和靶向治疗的研究相对较少，需要更多精心设计的研究来验证这一推论。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Otolaryngology 医学-耳鼻喉科学

CiteScore

4.40

自引率

4.00%

发文量

378

审稿时长

41 days

期刊介绍： Be fully informed about developments in otology, neurotology, audiology, rhinology, allergy, laryngology, speech science, bronchoesophagology, facial plastic surgery, and head and neck surgery. Featured sections include original contributions, grand rounds, current reviews, case reports and socioeconomics.