头颈癌术前新辅助化疗或免疫治疗：手术风险和病理反应的系统回顾和荟萃分析。

IF 5.5 2区医学 Q1 HEMATOLOGY

Critical reviews in oncology/hematology Pub Date : 2025-05-08 DOI:10.1016/j.critrevonc.2025.104742

Caique Mariano Pedroso , Mariana de Pauli Paglioni , Ana Gabriela Costa Normando , Aline Lauda Freitas Chaves , Luiz Paulo Kowalski , Gilberto de Castro Júnior , Leandro Luongo Matos , William Nassib Willian Junior , Thiago Bueno de Oliveira , Pedro de Marchi , Guilherme Harada , Milena Perez Mak , Carmen Silvia Passos Lima , Gustavo Arruda Viani , Fabio Ynoe Moraes , Andre Guimaraes Gouveia , Alan Roger Santos-Silva , Gustavo Nader Marta , On behalf of Latin American Cooperative Oncology Group (LACOG) - Head and Neck and Brazilian Group of Head and Neck Cancer (GBCP)

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引用次数: 0

摘要

目的：本系统综述和荟萃分析旨在评估接受新辅助化疗或免疫治疗的头颈部鳞状细胞癌患者的手术并发症、病理反应和疾病进展。方法：通过四个数据库（PubMed、Embase、Cochrane Library和Scopus）和灰色文献来源进行全面的文献检索，以确定头颈癌患者的新辅助治疗。仅纳入前瞻性临床试验。使用GRADE工具评价证据的确定性。结果：共纳入12项临床试验，包括6项新辅助化疗研究（顺铂+ 5-FU）和6项免疫治疗研究（纳武单抗、纳武单抗联合伊匹单抗、派姆单抗）。从给药到手术的平均时间为18至29天。总体手术并发症发生率为32.8%，其中派姆单抗组最低（9%），尼武单抗+伊匹单抗组最高（36.7%）。然而，尼武单抗组（RR = 1.68, p = 0.078）和化疗组（RR = 1.1, p = 0.70）手术并发症的风险比无统计学意义。完全病理反应（pCR）率低（4%），在顺铂和5-FU组最高（11%）。相比之下，Nivolumab联合Ipilimumab的部分病理反应（pPR）率达到58%。手术后疾病进展发生率为19.4%，Nivolumab + Ipilimumab组的进展率最低（7.7%）。对于化疗和免疫治疗，证据的确定性被评为非常低。结论：联合免疫治疗，特别是Nivolumab与Ipilimumab，显示出有利的pPR率和减少疾病进展，但增加了手术并发症。所有方案治疗的总体低pCR突出了改进治疗策略的必要性。

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Preoperative neoadjuvant chemotherapy or immunotherapy in head and neck cancer: A systematic review and meta-analysis of surgical risk and pathologic response

Objective

This systematic review and meta-analysis aimed to evaluate surgical complications, pathologic responses, and disease progression in patients with head and neck squamous cell carcinoma treated with neoadjuvant chemotherapy or immunotherapy.

Methods

A comprehensive literature search was conduct across four databases (PubMed, Embase, Cochrane Library, and Scopus) and grey literature sources to identify neoadjuvant therapies in head and neck cancer patients. Only prospective clinical trials were included. The certainty of evidence was appraised using GRADE tool.

Results

A total of 12 clinical trials me the inclusion criteria, comprising, six studies on neoadjuvant chemotherapy (Cisplatin and 5-FU) and six on immunotherapy (Nivolumab, Nivolumab plus Ipilimumab, Pembrolizumab) were analyzed. The mean time from drug administration to surgery ranged from 18 to 29 days. The overall surgical complication rate was 32.8 %, with the lowest observed in the Pembrolizumab group (9 %) and the highest in the Nivolumab plus Ipilimumab group (36.7 %). However, risk ratios for surgical complications were not statistically significant for Nivolumab (RR = 1.68, p = 0.078) or chemotherapy (RR = 1.1, p = 0.70). The complete pathologic response (pCR) rate was low (4 %), highest in the Cisplatin and 5-FU group (11 %). In contrast, the partial pathologic response (pPR) rate reached 58 % with Nivolumab plus Ipilimumab. Disease progression after surgery occurred in 19.4 %, with the lowest progression rate observed in the Nivolumab plus Ipilimumab group (7.7 %). The certainty of evidence was rated as very low for chemotherapy and low for immunotherapy.

Conclusion

Combination immunotherapy, particularly Nivolumab with Ipilimumab, demonstrated favorable pPR rates and reduced disease progression but was increased surgical complications. The overall low pCR across all regimen treatments highlight the need for improved therapeutic strategies.

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.