建立新型免疫-化疗联合方案中M1亚群的识别：多中心回顾性队列研究

Establishing M1 subdivision for de novo nasopharyngeal carcinoma patients receiving immuno-chemotherapy: A multicenter, retrospective cohort study

ORAL ONCOLOGY

影响因子:3.9

分区:医学2区 / 牙科与口腔外科2区肿瘤学3区

发表日期:2024 Dec

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

DOI: 10.1016/j.oraloncology.2024.107074

摘要

本研究旨在更好地管理新发转移性鼻咽癌（NPC）患者的免疫-化疗（PICT）治疗，便于个体生存预后的评估。纳入四个中心的首次接受PICT的转移性鼻咽癌患者。采用逻辑回归模型在训练队列（n=296）中建立预治疗总生存期（OS）预测的列线图（nomogram），并在验证队列中评估其性能。共纳入592例患者，随访中位时间为29.83个月。多因素分析显示，骨转移（HR 2.46，95% CI 1.01-6.21，p=0.049）和转移灶数量>3（HR 2.78，95% CI 1.24-6.24，p=0.013）为独立预后指标。基于此指标，提出新的两类别M1亚分类：M1a（无骨转移且转移灶>3个）和M1b（伴有骨转移且转移灶>3个）。M1a组患者的3年总生存率为87.1%，而M1b组为60.3%（p<0.001）。训练队列和验证队列的C指数分别为0.652和0.581。1、2、3年AUC值分别为0.69、0.68、0.68（训练队列）和0.64、0.6、0.6（验证队列）。DCA曲线也显示该列线图具有良好的临床实用性。所提出的M1亚分类能有效区分接受PICT治疗患者的生存预后。

Abstract

This study aims to better manage de novo metastatic nasopharyngeal carcinoma (NPC) patients receiving palliative immuno-chemotherapy (PICT), thereby easily determining individual survival outcomes.Patients with de novo metastatic NPC from four centers who received first-line PICT were included. We developed a nomogram for the pretherapy overall survival (OS) prediction using a logistic regression model in the training cohort (n = 296). We assessed the performance of this nomogram in a validation cohort.A total of 592 patients were included. The median follow-up time was 29.83 months. Bone metastasis (HR, 2.46; 95 % CI, 1.01-6.21; p = 0.049) and the number of metastatic lesions > 3 (HR, 2.78; 95 % CI, 1.24-6.24; p = 0.013) were independent prognostic indicators. A new two-category M1 subdivision was generated: M1a, defined by the absence of co-existing bone metastasis and the presence of more than three metastatic lesions; and M1b, characterized by the presence of co-existing bone metastasis and the presence of more than three metastatic lesions. The 3-year OS rates of patients with M1a vs. M1b were 87.1 % vs. 60.3 % (p < 0.001). The C-indexes were 0.652 and 0.581 in the training and validation cohorts. The 1-, 2-, and 3-year areas under the curve (AUC) were 0.69, 0.68, 0.68 in the training cohort and 0.64, 0.6, 0.6 in the validation cohort. DCA curves also indicated that the nomogram has good clinical utility.The proposed M1 subdivision provides good OS segregation for patients receiving PICT.