Predictive progression outcomes and risk stratification in patients with recurrent or metastatic nasopharyngeal carcinoma who received first-line immunochemotherapy

Danjie He; Yudong Zhang; Shuiqing He; Yuzhuo Zhang; Keyao Dai; Cheng Xu; Ying Huang

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Predictive progression outcomes and risk stratification in patients with recurrent or metastatic nasopharyngeal carcinoma who received first-line immunochemotherapy

Danjie He ^[3] ; Yudong Zhang ^[1] ; Shuiqing He ^[3] ; Yuzhuo Zhang ^[2] ; Keyao Dai ^[2] ; Cheng Xu ^[3] ; Ying Huang ^[3]
1. [1] Sun Yat-sen University
  
  Sun Yat-sen University
  
  China
2. [2] Guangzhou Medical University
  
  Guangzhou Medical University
  
  China
3. [3] Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
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Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 5, 2024, págs. 1209-1219
Idioma: inglés
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Resumen
- 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.