新辅助化疗免疫治疗为局部晚期口腔或口咽癌患者带来更高的生活质量：一项倾向评分匹配分析

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2025-02-26 DOI:10.1016/j.oraloncology.2025.107218

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

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引用次数: 0

摘要

背景：局部晚期口腔或口咽鳞状细胞癌（LAOOPSCC）患者在前期手术（US）后的预后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仍然未知。我们的目的是研究新辅助化疗免疫治疗（NACI）的抗肿瘤疗效和生活质量，并将其与US治疗laopscc的效果进行比较。方法对2021年1月至2023年1月间接受手术治疗的570例OOPSCC患者进行初步回顾，通过基于年龄、性别、临床T和N分期的倾向评分匹配，我们在NACI组和US组各获得51例无偏倚患者。以病理反应评价NACI组患者的抗肿瘤疗效。比较两组患者的术后生活质量（采用EORTC生活质量问卷头颈35进行评估）、无病生存期和总生存期。结果NACI组主要病理有效率为58.8%(30/51)，客观有效率为66.7%（34/51）。在NACI组中，患者手术时间较短（p = 0.001），术后住院时间较短（p = 0.041），术中出血量较少(p <；0.001)和较少的自由皮瓣重建(p <；0.001)。与US组患者相比，NACI组患者术后生活质量明显改善，包括感觉功能（12.7 vs. 23.0, p = 0.021）、言语问题(17.3 vs. 35.1, p <；0.001)，社交饮食（20.8 vs. 31.0, p = 0.020），社交接触(19.8 vs. 36.5, p <；0.001)和感觉不舒服（41.2比51.6,p = 0.021）。两组患者OS （p = 0.825）、DFS （p = 0.473）比较，差异均无统计学意义。结论NACI的安全性和可行性值得推广，NACI后的降压手术可提高患者术后生活质量。

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

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.

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.