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

作　　者：陈欣祎 翁一鸣[1] 王劲松[1] 魏家燕 彭敏[1] CHEN Xinyi;WENG Yiming;WANG Jinsong;WEI Jiayan;PENG Min(Cancer Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肿瘤中心,湖北武汉430060

出　　处：《肿瘤学杂志》2023年第9期777-782,共6页Journal of Chinese Oncology

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%(χ^(2)=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,χ^(2)=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EBVDNA检出阳性的患者PFS较差(7.0个月vs 11.9个月,χ^(2)=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,χ^(2)=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。[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%(χ^(2)=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,χ^(2)=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,χ^(2)=4.298,P=0.038).Subgroup analysis showed that patients with first-line immunotherapy had a better PFS than those with second

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 

分 类 号：R739.6[医药卫生—肿瘤]