化学免疫性疗法后，用局部区域放射治疗的从头转移性鼻咽癌的递归分区分析模型

化学免疫疗法是从头转移性鼻咽癌（DMNPC）的一线治疗，并具有额外的局部区域放疗（LRRT）显着延长了患者的生存率。然而，从头转移性鼻咽癌表现出相当大的异质性，导致患者结局的显着差异。我们为接受一线化学性免疫疗法和LRRT的患者开发了预后工具，并评估了局部疗法（LT）在不同风险水平的远处转移的益处。我们研究了364例DMNPC患者，接受了初始的铂基化学疗法和抗解细胞病毒蛋白1 Immunothy Papity的初始platinum疗法。将患者随机分为训练和验证队列（7：3比率）。主要终点是无进展生存率（PFS）。使用递归分区分析（RPA）开发了用于PFS的预后模型。一个RPA模型基于转移性病变，肝转移状态和治疗后Epstein-Barr病毒DNA水平，将患者分为五个预后组。生存分析确定了三个不同的风险群体。与中等和低风险组相比，高危患者的PFS明显较差（2年PFS率：训练队列：13.7％，对69.4％，对94.4％，P <0.001；验证队列：7.8％，65.1％对87.3％，P <0.001）。我们研究了LT对这些风险群体中远处转移的影响，发现只有中等风险组中的患者受益于LT（2年PFS率：77.5％对64.0％；危险比= 0.535，95％置信区间0.297-0.966，P = 0.035）。相反，在低风险（p = 0.218）和高风险的亚组（p = 0.793）中观察到LT的生存益处。 LRRT。该模型提供了个性化的治疗指导，表明中危组的患者可能会受益于LT遥远转移的LT，而高风险组和低风险组的患者可能不会受益。

Chemoimmunotherapy is the first-line treatment of de novo metastatic nasopharyngeal carcinoma (dmNPC), with additional locoregional radiotherapy (LRRT) significantly prolonging patient survival. De novo metastatic nasopharyngeal carcinoma, however, demonstrates considerable heterogeneity, resulting in significant variability in patient outcomes. We developed and validated a prognostic tool for patients undergoing first-line chemoimmunotherapy plus LRRT and to evaluate the benefit of local therapy (LT) for distant metastases across different risk levels.We studied 364 dmNPC patients receiving initial platinum-based chemotherapy and anti-programmed cell death protein 1 immunotherapy followed by LRRT. Patients were randomly divided into training and validation cohorts (7 : 3 ratio). The primary endpoint was progression-free survival (PFS). A prognostic model for PFS was developed using recursive partitioning analysis (RPA).An RPA model categorized patients into five prognostic groups based on number of metastatic lesions, liver metastasis status, and post-treatment Epstein-Barr virus DNA levels. Survival analysis identified three distinct risk groups. High-risk patients had significantly poorer PFS compared with medium- and low-risk groups (2-year PFS rate: training cohort: 13.7% versus 69.4% versus 94.4%, P < 0.001; validation cohort: 7.8% versus 65.1% versus 87.3%, P < 0.001). We investigated the impact of LT for distant metastases across these risk groups and found that only patients in the medium-risk group derived benefit from LT (2-year PFS rate: 77.5% versus 64.0%; hazard ratio = 0.535, 95% confidence interval 0.297-0.966, P = 0.035). Conversely, no survival benefit from LT for distant metastases was observed in the low-risk (P = 0.218) and high-risk subgroups (P = 0.793).Our RPA-based prognostic model integrates number of metastatic lesions, liver metastasis status, and post-treatment Epstein-Barr virus DNA levels to predict PFS in dmNPC patients undergoing chemoimmunotherapy plus LRRT. This model offers personalized treatment guidance, suggesting that patients in the medium-risk group may benefit from LT for distant metastases, while those in high- and low-risk groups may not.