{"title":"接受一线免疫化疗的复发性或转移性鼻咽癌患者的预测性进展结果和风险分层","authors":"Danjie He, Yudong Zhang, Shuiqing He, Yuzhuo Zhang, Keyao Dai, Cheng Xu, Ying Huang","doi":"10.1007/s12094-023-03344-w","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Progression after first-line immunochemotherapy (ICT) for recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) is a clinical concern due to subsequent limited treatment options. This study firstly predicted the progress outcome.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A cohort of 186 R/M NPC cases that received first-line ICT was included for developing a Cox regression model for progression-free survival (PFS) and risk stratification, which was verified by cross-validation. Discrimination and calibration were evaluated. Progression sites in risk groups was shown with a Sankey diagram.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Baseline predictors including liver metastasis, trend of plasma Epstein–Barr virus DNA copies, lymphocyte-to-monocyte ratio, and level of platelet and lactate dehydrogenase were identified for model construction, which stratify the cohort into low, middle, and high-risk groups. The overall concordance index (C-index) was 0.67 (95% CI 0.62–0.73). The area under the curve (AUC) was 0.68 (95% CI 0.60–0.76), 0.74 (95% CI 0.66–0.82), 0.75 (95% CI 0.65–0.84) at predicting 12, 18, and 24 months PFS, indicating a moderate accuracy. Cross-validation showed the model performance was robust. Compared with the low-risk group (median PFS: 24.4 months, 95% CI 18.4 months to not reached), the high-risk group (median PFS: 7.1 months, 95% CI 6.4–10.1 months; hazard risk: 7.4, 95% CI 4.4–12.4, p < 0.001) progressed with more liver metastasis after ICT resistance.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>It was the first study that described the risk factors and progression characteristics in R/M NPC patients who received first-line ICT, investigating the progression patterns, which was helpful to identify patients with different risks and help guide personalized interventions.</p>","PeriodicalId":10166,"journal":{"name":"Clinical and Translational Oncology","volume":"7 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive progression outcomes and risk stratification in patients with recurrent or metastatic nasopharyngeal carcinoma who received first-line immunochemotherapy\",\"authors\":\"Danjie He, Yudong Zhang, Shuiqing He, Yuzhuo Zhang, Keyao Dai, Cheng Xu, Ying Huang\",\"doi\":\"10.1007/s12094-023-03344-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Purpose</h3><p>Progression after first-line immunochemotherapy (ICT) for recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) is a clinical concern due to subsequent limited treatment options. This study firstly predicted the progress outcome.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>A cohort of 186 R/M NPC cases that received first-line ICT was included for developing a Cox regression model for progression-free survival (PFS) and risk stratification, which was verified by cross-validation. Discrimination and calibration were evaluated. Progression sites in risk groups was shown with a Sankey diagram.</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>Baseline predictors including liver metastasis, trend of plasma Epstein–Barr virus DNA copies, lymphocyte-to-monocyte ratio, and level of platelet and lactate dehydrogenase were identified for model construction, which stratify the cohort into low, middle, and high-risk groups. The overall concordance index (C-index) was 0.67 (95% CI 0.62–0.73). The area under the curve (AUC) was 0.68 (95% CI 0.60–0.76), 0.74 (95% CI 0.66–0.82), 0.75 (95% CI 0.65–0.84) at predicting 12, 18, and 24 months PFS, indicating a moderate accuracy. Cross-validation showed the model performance was robust. Compared with the low-risk group (median PFS: 24.4 months, 95% CI 18.4 months to not reached), the high-risk group (median PFS: 7.1 months, 95% CI 6.4–10.1 months; hazard risk: 7.4, 95% CI 4.4–12.4, p < 0.001) progressed with more liver metastasis after ICT resistance.</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusion</h3><p>It was the first study that described the risk factors and progression characteristics in R/M NPC patients who received first-line ICT, investigating the progression patterns, which was helpful to identify patients with different risks and help guide personalized interventions.</p>\",\"PeriodicalId\":10166,\"journal\":{\"name\":\"Clinical and Translational Oncology\",\"volume\":\"7 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Translational Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12094-023-03344-w\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Translational Oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12094-023-03344-w","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的复发性或转移性鼻咽癌(R/M NPC)一线免疫化疗(ICT)后的进展是临床关注的问题,因为后续治疗方案有限。本研究首先对进展结果进行了预测。方法纳入了186例接受一线ICT治疗的R/M鼻咽癌病例,建立了无进展生存期(PFS)和风险分层的Cox回归模型,并通过交叉验证进行了验证。对判别和校准进行了评估。结果 在构建模型时,确定了包括肝转移、血浆 Epstein-Barr 病毒 DNA 拷贝数趋势、淋巴细胞与单核细胞比率、血小板和乳酸脱氢酶水平在内的基线预测因素,并将队列分为低、中、高风险组。总体一致性指数(C-index)为 0.67(95% CI 0.62-0.73)。在预测 12、18 和 24 个月的 PFS 时,曲线下面积(AUC)分别为 0.68(95% CI 0.60-0.76)、0.74(95% CI 0.66-0.82)、0.75(95% CI 0.65-0.84),表明准确度适中。交叉验证结果表明,该模型性能稳健。与低风险组(中位 PFS:24.4 个月,95% CI 18.4 个月至未达到)相比,高风险组(中位 PFS:7.1 个月,95% CI 6.4-10.1 个月;危险风险:7.4,95% CI 4.4-12.4,p <0.001)在 ICT 耐药后出现更多肝转移。结论这是第一项描述接受一线ICT治疗的R/M鼻咽癌患者风险因素和进展特征的研究,调查了其进展模式,有助于识别不同风险的患者,帮助指导个性化干预。
Predictive progression outcomes and risk stratification in patients with recurrent or metastatic nasopharyngeal carcinoma who received first-line immunochemotherapy
Purpose
Progression after first-line immunochemotherapy (ICT) for recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) is a clinical concern due to subsequent limited treatment options. This study firstly predicted the progress outcome.
Methods
A cohort of 186 R/M NPC cases that received first-line ICT was included for developing a Cox regression model for progression-free survival (PFS) and risk stratification, which was verified by cross-validation. Discrimination and calibration were evaluated. Progression sites in risk groups was shown with a Sankey diagram.
Results
Baseline predictors including liver metastasis, trend of plasma Epstein–Barr virus DNA copies, lymphocyte-to-monocyte ratio, and level of platelet and lactate dehydrogenase were identified for model construction, which stratify the cohort into low, middle, and high-risk groups. The overall concordance index (C-index) was 0.67 (95% CI 0.62–0.73). The area under the curve (AUC) was 0.68 (95% CI 0.60–0.76), 0.74 (95% CI 0.66–0.82), 0.75 (95% CI 0.65–0.84) at predicting 12, 18, and 24 months PFS, indicating a moderate accuracy. Cross-validation showed the model performance was robust. Compared with the low-risk group (median PFS: 24.4 months, 95% CI 18.4 months to not reached), the high-risk group (median PFS: 7.1 months, 95% CI 6.4–10.1 months; hazard risk: 7.4, 95% CI 4.4–12.4, p < 0.001) progressed with more liver metastasis after ICT resistance.
Conclusion
It was the first study that described the risk factors and progression characteristics in R/M NPC patients who received first-line ICT, investigating the progression patterns, which was helpful to identify patients with different risks and help guide personalized interventions.