一项多中心回顾性研究：转移灶放疗对新发转移性鼻咽癌患者接受局部放疗和化疗免疫治疗的疗效。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-23 DOI:10.1016/j.radonc.2025.111160

Shui-Qing He , Shu-Hui Lv , Si-Qing Wen , Lin-Wang , Ya-Hui Yu , Guo-Yi Zhang , Ding-Sheng Peng , Wei-Xin Bei , Chun-Lan Chen , Ze-Yu Zhao , Ying Huang , Yan-Qun Xiang , Guo-Ying Liu

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引用次数: 0

摘要

背景和目的：新发转移性鼻咽癌（dmNPC）表现出异质性的生存结果。虽然化疗免疫治疗联合局部放疗（LRRT）改善了预后，但转移灶放疗（MLRT）的作用仍然存在争议，特别是在免疫治疗的背景下。本研究旨在评估MLRT在接受化疗免疫治疗和LRRT的dmNPC患者中的疗效，并建立MLRT受益人的预后模型。材料和方法：该研究包括来自四个不同中心的347例dmNPC患者。所有患者均接受≥2个周期的一线化疗免疫治疗和LRRT。77例患者接受MLRT治疗。采用Cox回归分析预后因素。采用递归划分分析（RPA）模型构建风险分层的预后模型。跨风险层比较MLRT组和非MLRT组的无进展生存期（PFS）差异。结果：MLRT受者表现出优越的中位PFS（未达到vs. 34.87 个月，p = 0.006）。RPA模型根据转移灶数量、肝转移和治疗后eb病毒（EBV） DNA将患者分为三个风险组。低、中、高风险组的3年PFS率分别为71.4 %、39.2 %和12.3 %。MLRT显著改善了低危患者的3年PFS(82.8 % vs. 69.1 %,p = 0.031)，但在中危组无显著改善。独立的不良预后因素包括治疗后可检测到的EBV DNA （HR = 3.36）、肝转移（HR = 1.5）和bbb50转移灶（HR = 1.52）。结论：MLRT有利于低风险特征（转移有限，EBV DNA检测不到）的dmNPC患者。在免疫治疗时代，使用转移负担和EBV DNA状态进行风险分层可以指导个性化的MLRT决策。

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Efficacy of metastatic lesion radiotherapy in de novo metastatic nasopharyngeal carcinoma patients receiving local regional radiotherapy and chemo-immunotherapy: a multicenter retrospective study

Background and purpose

De novo metastatic nasopharyngeal carcinoma (dmNPC) exhibits heterogeneous survival outcomes. While combining chemo-immunotherapy with locoregional radiotherapy (LRRT) improves outcomes, the role of metastatic lesion radiotherapy (MLRT) remains controversial, especially in the context of immunotherapy. This study aims to evaluate MLRT’s efficacy in dmNPC patients receiving chemo-immunotherapy and LRRT and establish a prognostic model for identifying MLRT beneficiaries.

Materials and methods

The study comprised of 347 dmNPC patients from four different centers. All patients received ≥2 cycles of first-line chemo-immunotherapy and LRRT. MLRT was administered to 77 patients. Prognostic factors were analyzed using Cox regression. A recursive partitioning analysis (RPA) model was employed to construct a prognostic model for risk stratification. Progression-free survival (PFS) differences between MLRT and non-MLRT groups were compared across risk strata.

Results

MLRT recipients demonstrated superior median PFS (not reached vs. 34.87 months, p = 0.006). The RPA model classified patients into three risk groups based on the number of metastatic lesions, liver metastasis, and post-treatment Epstein-Barr Virus (EBV) DNA. The 3-year PFS rates for the low-, medium-, and high-risk groups were 71.4 %, 39.2 %, and 12.3 %. MLRT significantly improved 3-year PFS in low-risk patients (82.8 % vs. 69.1 %, p = 0.031), but not in medium or high-risk groups. Independent adverse prognostic factors included detectable post-treatment EBV DNA (HR = 3.36), liver metastasis (HR = 1.5), and >5 metastatic lesions (HR = 1.52).

Conclusion

MLRT benefits dmNPC patients with low-risk features (limited metastases, undetectable EBV DNA). Risk stratification using metastatic burden and EBV DNA status may guide personalized MLRT decisions in the immunotherapy era.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.