| 陈欣祎,翁一鸣,王劲松,等.免疫治疗头颈部鳞状细胞癌的预后因素分析[J].肿瘤学杂志,2023,29(9):777-782. |
| 免疫治疗头颈部鳞状细胞癌的预后因素分析 |
| Factors Related Clinical Outcome of Immunotherapy for Head and Neck Squamous Cell Carcinoma |
| 投稿时间：2023-03-23 |
| DOI：10.11735/j.issn.1671-170X.2023.09.B009 |
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| 中文关键词: 头颈部鳞状细胞癌 免疫检查点抑制剂 预后营养指数 生存分析 |
| 英文关键词:head and neck squamous cell carcinoma immune checkpoint inhibitor prognostic nutritional index survival analysis |
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| 中文摘要: |
| 摘 要：［目的］ 评估免疫治疗头颈部鳞状细胞癌(head and neck squamous cell carcinoma，HNSCC)患者疗效及预后影响因素。［方法］ 回顾性收集接受PD-1单克隆抗体治疗的HNSCC患者的临床和生存资料。采用Kaplan-Meier法分析基线特征（患者临床病理特征、联合治疗方案）和预后之间的关系。基于患者的生存状况和生存时间，使用X-tile软件找到预后营养指数(PNI)的最佳截断值使之成为二分类变量。采用Cox回归模型进行单因素和多因素分析，单因素分析中显著的变量包含在多因素Cox回归模型中，确定独立预后因素。P<0.05为差异有统计学意义。［结果］ 研究人群中位无进展生存期（PFS）为9.0个月（95%CI：7.6~10.4）。患者的性别、吸烟、饮酒、肿瘤分化程度、HPV感染、原发部位、临床分期均不是生存危险因素。年龄在60岁及以下的患者有较好的PFS（10.7个月 vs 6.6 个月，P=0.024）。64例患者接受免疫治疗作为一线治疗，接受一线治疗的患者有较高的总缓解率（ORR，57.8%）。73例患者接受免疫联合化疗，18例患者接受免疫联合化疗加抗血管生成治疗，加用抗血管生成组ORR为72.2%，免疫联合化疗组ORR为42.4%（χ2=5.120，P=0.024）。接受放疗的患者较未接受的患者PFS更好（P=0.049）。PNI＞49.4与更长的PFS有关（11.3个月 vs 7.3个月，χ2=5.153，P=0.023）。对于非鼻咽癌患者，免疫治疗前行病损切除手术（淋巴结转移的患者进行选择性淋巴清扫术）患者有更长的PFS（P＜0.05）。对于鼻咽癌患者，免疫治疗前EBV-DNA检出阳性的患者PFS较差（7.0个月 vs 11.9 个月，χ2=4.298，P=0.038）。治疗线亚组分析显示，一线免疫治疗患者PFS优于二线和三线及以上免疫治疗患者（10.9个月 vs 5.9个月 vs 6.7 个月，χ2=8.353，P=0.015）。多因素Cox分析显示，免疫治疗线数是PFS的独立预后因素。［结论］ 免疫联合化疗加抗血管生成治疗可以提高HNSCC患者疗效，免疫治疗线数是影响患者PFS的独立预后因素。 |
| 英文摘要: |
| Abstract： ［Objective］ To evaluate the factors influencing the clinical outcome of immunotherapy in patients with head and neck squamous carcinoma（HNSCC）. ［Methods］ Clinical data of 94 HNSCC patients who received PD-1 monoclonal antibody treatment in Renmin Hospital of Wuhan University were retrospectively analyzed. The relationship between clinical and pathological factors and clinical outcomes was analyzed with Kaplan-Meier method. X-tile software was used to determine the optimal cut-off value of prognostic nutritional index(PNI) . Univariate and multivariate Cox regression was used analyze the predictive factors of clinical outcomes. ［Results］ The median progression-free survival (PFS) was 9.0 months (95%CI： 7.6~10.4 months) in this series of patients. Gender， smoking and drinking status， tumor differentiation， HPV infection， primary site， and clinical stage were not significantly correlated with the survival of patients. Patients aged 60 or younger had a better survival than those aged over 60 (10.7 months vs 6.6 months， P=0.024). Sixty four patients who received immunotherapy as first-line treatment had an overall response rate (ORR) of 57.8%， 73 patients who received immunotherapy combined with chemotherapy had an ORR of 42.4%，while 18 patients who received immunotherapy combined with chemotherapy and anti-angiogenic therapy had a ORR of 72.2% (χ2=5.120， P=0.024). Patients who received radiotherapy had a better PFS than those who did not (P=0.049). Patients with baseline PNI >49.4 had longer PFS than those with PNI ≤49.4 (11.3 months vs 7.3 months， χ2=5.153， P=0.023). Non-nasopharyngeal carcinoma patients who underwent lesion resection surgery (selective lymphadenectomy for those with lymph node metastasis) before receiving immunotherapy had a longer PFS(P＜0.05). Nasopharyngeal carcinoma patients with positive EBV-DNA before immunotherapy had a poorer prognosis than those with negative EBV-DNA (7.0 months vs 11.9 months， χ2=4.298， P=0.038). Subgroup analysis showed that patients with first-line immunotherapy had a better PFS than those with second-line and third-line or higher patients (10.9 months vs 5.9 months vs 6.7 months， χ2=8.353， P=0.015). Multivariate Cox analysis showed that the immunotherapy line was an independent prognostic factor for PFS. ［Conclusion］ Immunotherapy combined with chemotherapy and anti-angiogenic therapy can improve therapeutic efficacy， and the number of immunotherapy lines is an independent prognostic factor affecting progression-free survival in patients with HNSCC. |
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