[摘 要] 目的：探讨复发/转移性鼻咽癌（NPC）接受含PD-1单抗免疫治疗的临床特征和预后影响因素。方法：回顾性分析 2019年3月至2024年7月期间南部战区总医院确诊的95例NPC患者的临床资料和外周血生化及免疫学指标。预后分析采用 Kaplan-Meier曲线，组间比较使用Log-rank检验，采用Cox比例风险模型进行单因素和多因素分析。结果：95例患者中男性81 例，女性14例，中位年龄49.72岁（16~74岁），Ⅳ期91例（95.79%），所有患者均采用免疫治疗，联合或不联合化疗方案治疗，中位无 进展生存期（mPFS）为10.5个月，客观缓解率（ORR）70.53%，疾病控制率（DCR）89.47%，接受含铂治疗方案患者PFS相对更长，且 差异有统计学意义。紫杉醇 + 顺铂 + 氟尿嘧啶（TPF）对比吉西他滨 + 顺铂（GP）和紫杉醇 + 顺铂（TP）显示出更长的PFS，但差异 无统计学意义。不同PD-1单抗治疗组间的PFS未显示出有统计学意义的差异。单因素及多因素Cox回归分析结果显示，肿瘤复 发状态、初始血浆EBV感染状态、治疗周期数、基线外周血SII是复发/转移性NPC患者接受PD-1抑制剂治疗疗效预测的独立相 关因素（均P < 0.05），并且非复发患者、初始血浆EBV DNA阳性、接受 ≥ 4治疗周期、基线外周血SII < 772.81的患者接受PD-1抑 制剂治疗预后相对更好。结论：在接受PD-1抑制剂治疗的复发/转移性NPC患者中，非复发患者、初始血浆EBV DNA阳性、≥ 4 治疗周期且外周血SII < 772.81者PFS相对更长，可早期识别免疫治疗效果不佳患者并精准干预。

[Abstract] Objective: To investigate the clinical characteristics and prognostic factors of patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) who received PD-1 inhibitor-based immunotherapy. Methods: A retrospective analysis was conducted on 95 patients with NPC diagnosed at General Hospital of the Southern Theater Command between March 2019 and July 2024. Clinical data, peripheral blood biochemical parameters, and immunological indicators were collected. Kaplan-Meier survival curves were used for prognostic comparisons. Log-rank test was used for comparison among groups. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Results: Among the 95 patients, 81 were male and 14 were female, with a median age of 49.72 years (16-74 years). A total of 91 patients (95.79%) had stage Ⅳ disease. All patients received immunotherapy with or without chemotherapy. The median progression-free survival (mPFS) was 10.5 months, with an objective response rate (ORR) of 70.53% and a disease control rate (DCR) of 89.47%. Patients receiving platinum-based regimens had significantly longer PFS than those receiving non-platinum regimens. The paclitaxel + cisplatin + fluorouracil (TPF) regimen showed a longer PFS compared with the gemcitabine + cisplatin (GP) and paclitaxel + cisplatin (TP) regimen, although the differences were not statistically significant. No significant PFS differences were observed among different PD-1 inhibitor subgroups. Univariate and multivariate Cox analyses identified tumor recurrence status, baseline plasma EBV DNA status, number of treatment cycles, and baseline peripheral blood immune-inflammation index SII as independent efficacy predictors of PD-1 inhibitor-based therapy for patients with recurrent or metastatic NPC (all P < 0.05). Non-recurrent disease, baseline plasma EBV DNA positivity, 4 or more treatment cycles, and baseline peripheral blood SII < 772.81 were associated with better outcomes. Conclusion: In recurrent or metastatic NPC patients treated with PD-1 inhibitors, non-recurrent disease, baseline EBV DNA positivity, 4 or more treatment cycles, and peripheral blood SII < 772.81 were associated with prolonged PFS. These factors may help early identification of patients with suboptimal immunotherapy responses and enable timely individualized intervention.

[基金项目] 广州市科技计划项目（2023A04J2056）